Group Grandfathering Notice of Intent Forms

The Patient Protection and Affordable Care Act (PPACA), also known as the federal health reform law, was enacted on March 23, 2010. This law established new benefits that increase the coverage under many health plans. This law also creates the option for Companies to elect “grandfathered status” for their qualified health plan(s), and be exempted from some provisions under the law.

This information is applicable only for renewing groups that have chosen to retain grandfathered status. As part of that renewal groups will have to determine whether they wish to elect this grandfathered status for any of the health plans they offer to their employees.

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Non-Grandfathered: If you do not intend to retain grandfathered status, no additional action is required on your part. You may continue with your renewal process.

Grandfathered: If you do intend to remain grandfathered, you will need to complete a Notice of Intent. It is important to consider the following:

  • Your coverage already includes all PPACA mandated benefits and grandfathering will not remove these changes.
  • You must return a Notice of Intent with your renewal package.

CareFirst will not treat your plan as a grandfathered plan unless you complete and return the Notice of Intent to us with your renewal forms. In addition, if you select benefit changes or have made benefit changes that cause a loss of grandfathered status as noted in the Notice of Intent letter, then grandfathered status will be lost regardless of your designated intention to remain grandfathered in the Notice of Intent.

1-50 and 51-199 Risk Groups Only

A Word version and a PDF version of these forms are available.

  • The Word version will let you save an electronic copy on your own computer, fill in the form, and print it.
  • The PDF version must be printed out and completed by hand.
  • Please make a copy for your records before sending in the forms.
1-50 Notice of Intent Word PDF
51-199 Risk Notice of Intent Word PDF

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