The Union Roofers Heath and Welfare Fund believes that its medical and prescription drug coverage, provided through the Indemnity Plan, and for participants covered under the insured Kaiser Permanente and Health Net Plans is a “grandfathered health plan” under the Patient Protection and Affordable Care Act of 2020 (PPACA or 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 plan 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 apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the Fund Administrator at 9901 Paramount Blvd., Suite 211, Downy, California, telephones: (562) 927-1434.
You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1 (866) 444-3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.