U.S. Code » Title 42 » Chapter CHAPTER 157— QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS › Subchapter SUBCHAPTER II— OTHER PROVISIONS

42 U.S.C. § 18011

Preservation of right to maintain existing coverage

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(a) No changes to existing coverage(1) In general

Nothing in this Act (or an amendment made by this Act) shall be construed to require that an individual terminate coverage under a group health plan or health insurance coverage in which such individual was enrolled on March 23, 2010.

(2) Continuation of coverage

Except as provided in paragraph (3), with respect to a group health plan or health insurance coverage in which an individual was enrolled on March 23, 2010, this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply to such plan or coverage, regardless of whether the individual renews such coverage after March 23, 2010.

(3) Application of certain provisions

The provisions of sections 2715 [42 U.S.C. 300gg–15] and 2718 [42 U.S.C. 300gg–18] of the Public Health Service Act (as added by subtitle A) shall apply to grandfathered health plans for plan years beginning on or after March 23, 2010.

(4) Application of certain provisions(A) In generalThe following provisions of the Public Health Service Act [42 U.S.C. 201 et seq.] (as added by this title) 11 See References in Text note below. shall apply to grandfathered health plans for plan years beginning with the first plan year to which such provisions would otherwise apply:(i) Section 2708 [42 U.S.C. 300gg–7] (relating to excessive waiting periods).(ii) Those provisions of section 2711 [42 U.S.C. 300gg–11] relating to lifetime limits.(iii) Section 2712 [42 U.S.C. 300gg–12] (relating to rescissions).(iv) Section 2714 [42 U.S.C. 300gg–14] (relating to extension of dependent coverage).(B) Provisions applicable only to group health plans(i) Provisions described

Those provisions of section 2711 [42 U.S.C. 300gg–11] relating to annual limits and the provisions of section 2704 [42 U.S.C. 300gg–3] (relating to pre-existing condition exclusions) of the Public Health Service Act (as added by this subtitle) shall apply to grandfathered health plans that are group health plans for plan years beginning with the first plan year to which such provisions otherwise apply.

(ii) Adult child coverage

For plan years beginning before January 1, 2014, the provisions of section 2714 of the Public Health Service Act [42 U.S.C. 300gg–14] (as added by this subtitle) shall apply in the case of an adult child with respect to a grandfathered health plan that is a group health plan only if such adult child is not eligible to enroll in an eligible employer-sponsored health plan (as defined in section 5000A(f)(2) of title 26) other than such grandfathered health plan.

(5) Application of additional provisions

Sections 300gg–111, 300gg–112, and 300gg–117 of this title shall apply to grandfathered health plans for plan years beginning on or after January 1, 2022.

(b) Allowance for family members to join current coverage

With respect to a group health plan or health insurance coverage in which an individual was enrolled on March 23, 2010, and which is renewed after such date, family members of such individual shall be permitted to enroll in such plan or coverage if such enrollment is permitted under the terms of the plan in effect as of March 23, 2010.

(c) Allowance for new employees to join current plan

A group health plan that provides coverage on March 23, 2010, may provide for the enrolling of new employees (and their families) in such plan, and this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply with respect to such plan and such new employees (and their families).

(d) Effect on collective bargaining agreements

In the case of health insurance coverage maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers that was ratified before March 23, 2010, the provisions of this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply until the date on which the last of the collective bargaining agreements relating to the coverage terminates. Any coverage amendment made pursuant to a collective bargaining agreement relating to the coverage which amends the coverage solely to conform to any requirement added by this subtitle or subtitle A (or amendments) shall not be treated as a termination of such collective bargaining agreement.

(e) Definition

In this title,1 the term “grandfathered health plan” means any group health plan or health insurance coverage to which this section applies.

(Pub. L. 111–148, title I, § 1251, title X, § 10103(d), Mar. 23, 2010, 124 Stat. 161, 895; Pub. L. 111–152, title II, § 2301(a), Mar. 30, 2010, 124 Stat. 1081; Pub. L. 116–260, div. BB, title I, § 102(d)(2), Dec. 27, 2020, 134 Stat. 2797.)Editorial NotesReferences in Text

This Act, referred to in subsec. (a)(1), is Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 119, known as the Patient Protection and Affordable Care Act. For complete classification of this Act to the Code, see Short Title note set out under section 18001 of this title and Tables.

This subtitle, referred to in subsecs. (a)(2), (4)(B), (c), and (d), is subtitle C (§§ 1201–1255) of title I of Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 154, which enacted this subchapter and sections 300gg to 300gg–2 and 300gg–4 to 300gg–7 of this title, transferred section 300gg of this title to section 300gg–3 of this title, amended sections 300gg–1 and 300gg–4 of this title, and enacted provisions set out as a note under section 300gg of this title. For complete classification of subtitle C to the Code, see Tables.

Subtitle A, referred to in subsecs. (a)(2), (3), (c), and (d), is subtitle A (§§ 1001–1004) of title I of Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 130, which enacted sections 300gg–11 to 300gg–19, 300gg–93, and 300gg–94 of this title, transferred sections 300gg–4 to 300gg–7 and 300gg–13 of this title to sections 300gg–25 to 300gg–28 and 300gg–9 of this title, respectively, amended sections 300gg–11, 300gg–12, and 300gg–21 to 300gg–23 of this title, and enacted provisions set out as a note under section 300gg–11 of this title. For complete classification of subtitle A to the Code, see Tables.

The Public Health Service Act, referred to in subsec. (a)(4)(A), is act July 1, 1944, ch. 373, 58 Stat. 682, which is classified generally to chapter 6A (§ 201 et seq.) of this title. For complete classification of this Act to the Code, see Short Title note set out under section 201 of this title and Tables.

This title, referred to in subsecs. (a)(4)(A) and (e), is title I of Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 130, which enacted this chapter and enacted, amended, and transferred numerous other sections and notes in the Code. For complete classification of title I to the Code, see Tables.

Amendments

2020—Subsec. (a)(5). Pub. L. 116–260 added par. (5).

2010—Subsec. (a)(2). Pub. L. 111–148, § 10103(d)(1), substituted “Except as provided in paragraph (3), with” for “With”.

Subsec. (a)(3). Pub. L. 111–148, § 10103(d)(2), added par. (3).

Subsec. (a)(4). Pub. L. 111–152 added par. (4).

Statutory Notes and Related SubsidiariesEffective Date of 2020 Amendment

Amendment by Pub. L. 116–260 applicable with respect to plan years beginning on or after Jan. 1, 2022, see section 102(e) of div. BB of Pub. L. 116–260, set out as a note under section 8902 of Title 5, Government Organization and Employees.

Effective Date

Section effective Mar. 23, 2010, see section 1255(1) of Pub. L. 111–148, set out as a note under section 300gg of this title.

Notes of Decisions
Cited in 49 cases (1 in the last 5 years), 2011–2022 · leading case: Little Sisters of the Poor Saints Peter & Paul Home v. Pennsylvania, 140 S. Ct. 2367 (2020).
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Little Sisters of the Poor Saints Peter & Paul Home v. Pennsylvania, 140 S. Ct. 2367 (2020). · cites it 2× “§ 4980H(c)(2) ; 42 U.S.C. § 18011 . According to a recent survey, 13% of the 153 million Americans with employer-sponsored health insurance are enrolled in a grandfathered plan, while only 56% of small firms provide health insurance.”
Burwell v. Hobby Lobby Stores, Inc., 134 S. Ct. 2751 (2014). · cites it 2× “42 U.S.C. §§ 18011 (a), (e). And employers with fewer than 50 employees are not required to provide health insurance at all.”
Cyril Korte v. HHS, 735 F.3d 654 (7th Cir. 2013). · cites it 2× “See 42 U.S.C. § 18011 . Grandfathering is a transitional measure; this category will shrink as employer-based plans existing 8 Nos.”
Florida Ex Rel. Attorney Gen. v. United States Dep't of Health & Human Servs., 648 F.3d 1235 (11th Cir. 2011). · cites it 4× “[50] 42 U.S.C. § 18011 (a)(1), (e). While not subject to many of the Act's product reforms, grandfathered plans must comply with some provisions, among them the extension of dependent coverage until age 26, the medical-loss ratio requirements, and the prohibitions on (1)…”
Real Alternatives, Inc. v. Sec'y Dep't of Health & Human Servs., 867 F.3d 338 (3rd Cir. 2017). · cites it 2× “2751, 2764 (2014) (citing 42 U.S.C. §§ 18011 (a), (e)). They “need not comply with many of the [ACA’s] requirements, including the [C]ontraceptive [M]andate.”
Commonwealth of Pennsylvania v. President United States, 930 F.3d 543 (3rd Cir. 2019). · cites it 2× “42 U.S.C. § 18011 (a), (e). Congress also considered and rejected a statutory conscience amendment that would have operated similarly to the challenged Exemptions.”
The Roman Catholic Archdiocese of Atlanta v. Sec'y of the U.S. Dep't of Health & Human Servs., 818 F.3d 1122 (11th Cir. 2016). · cites it 2× “42 U.S.C. § 18011 (a), (e). Other changes instituted by the ACA do apply to grandfathered health plans, including extensions of dependent coverage for adult children under the age of twenty-six and prohibitions on excessive waiting periods, lifetime benefits limits, and…”
Moda Health Plan, Inc. v. United States, 892 F.3d 1311 (Fed. Cir. 2018). · cites it 2× “42 U.S.C. § 18011 . This meant that insurers expected the pool of participants in the exchanges to include both previously uninsured individuals as well as individuals whose previous cover- age terminated because their respective plans did not comply with the ACA and did not…”
Pennsylvania v. Trump, 351 F. Supp. 3d 791 (E.D. Pa. 2019). · cites it 3× “42 U.S.C. § 18011 (exempting "grandfathered" plans); see also 29 C.”
Grace Schs. v. Sylvia Mathews Burwell, 801 F.3d 788 (7th Cir. 2015). · cites it 3× “See 42 U.S.C. § 18011 . Grandfathered plans are those health plans that need not comply with the coverage requirements of the ACA because they were in existence when the ACA was adopted and have not made certain changes to the terms of their plans.”
Hobby Lobby Stores, Inc. v. Sebelius, 723 F.3d 1114 (10th Cir. 2013). “See 42 U.S.C. § 18011 (a)(2). Grandfathered plans may remain so indefinitely.”
Gilardi v. United States Dep't of Health & Human Servs., 733 F.3d 1208 (D.C. Cir. 2013). · cites it 2× “§ 4980H(c)(2)(A); 42 U.S.C. § 18011 ; 45 C.F.R. §§ 147.130 (a)(1)(iv)(A)–(B).”
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