Grandfathered Plan, What Do I Do About Pre-existing Conditions Costs?

I have an individual health insurance plan through United Healthcare that I purchased in 2007. I am currently being charged more than $300 a month than the base rate for this plan because of the tier rating based on answers to my medical questions on my original application in 2007. Is it legal for UHC to charge this higher amount? I don’t believe it was ever disclosed to me in my plan materials that this was a “Grandfather Plan.” I just heard this information when I tried to increase my deductible on 1/15 and was told about the tier rating.

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My “grandfathered in” plan purchased before 2010,
Had me deny coverage for kidneys in 2011.
That major change should have required Bc/bs of Florida to cancell my plan and get me a new plan with no pre-existing since it happened after 2010, right?

“How Does a Health Plan Lose Grandfathered Status Under the Affordable Care Act?
Generally, a plan will lose grandfathered status if any of the following changes are made after March 23, 2010. These rules apply separately to each “benefit package” offered by an employer:

A significant cut or reduction in benefits by eliminating all or substantially all of the benefits to diagnose or treat a condition, or any necessary element to diagnose or treat a condition. ”

So I think now that major kidney work over $100,000 denied is a violation of Bc/bs not enforcing the law to mandatorily provide me another plan with kidneys coverage! 2011 was too late to start denying pre existing. Right?


A grandfathered plan can still deny preexisting conditions even after the provisions went into effect. “A major change” that is a general term, when it comes to the actual rules it is specific changes that would result in them having to change the plan. This all said you can absolutely appeal this decision. Really sorry to hear this. Exactly why the ACA is so important and why the whole “keeping your plan” thing was a double edged sword.

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