A "non-grandfathered health plan" must comply with certain consumer protections under the Affordable Care Act (ACA) and cover certain in-network preventive services with $0 co-payments to the enrolled participants, such as those listed below:
– Routine physicals
– Immunizations
– Colonoscopies
– Mammograms
– Birth control prescriptions and other preventive prescriptions
For a complete list of preventive services and medications, please contact the applicable health plan.
Effective July 1, 2017, the HIP Preferred HMO plan offered to City employees through the City of New York Health Benefits Program is a “non-grandfathered health plan” under the Affordable Care Act.
Effective July 1, 2016, the GHI-Comprehensive Benefits Program/Empire BlueCross BlueShield Plan (GHI-CBP) offered to City employees through the City of New York Health Benefits Program is a “non-grandfathered health plan” under the Affordable Care Act.
Effective July 1, 2016, the DC 37 Med-Team offered to DC 37 City employees through the City of New York Health Benefits Program is a “non-grandfathered health plan” under the Affordable Care Act.
Effective January 1, 2016, the MetroPlus Gold plan offered to City employees through the City of New York Health Benefits Program is a “non-grandfathered health plan” under the Affordable Care Act.
The City of New York believes that all of the other health plans currently, as of July 2017, offered as health benefits coverage to City employees through the City of New York Health Benefits Program are “grandfathered health plans” under the Patient Protection and Affordable Care Act (the Affordable Care Act).
As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your health plan coverage may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.
Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed, in writing only, to:
City of New York Health Benefits Program
22 Cortlandt Street, 12th Floor
New York, NY 10007
Attention: Grandfathered Plan Status
Click on a Health Plan name in order to see a summary of that Plan (PDF).
GHI Emblem Health
Anthem Blue Cross and Blue Shield
