According to HHS, grandfathered health plans will be able to make routine changes to their policies and maintain their status. These routine changes include cost adjustments to keep pace with medical inflation, adding new benefits, making modest adjustments to existing benefits, voluntarily adopting new consumer protections under the new law, or making changes to comply with state or other federal laws. Premium changes are not taken into account when determining whether or not a plan is grandfathered.

Plans will lose their grandfathered status if they choose to make significant changes that reduce benefits or increase costs to consumers. If a plan loses its grandfathered status, then consumers in these plans will gain additional new benefits including:

• Coverage of recommended prevention services with no cost sharing; and
• Patient protections such as access to OB-GYNs and pediatricians without a referral by a separate primary care provider.

Details about what routine changes insurers and employers can make without losing their grandfathered status, and the projected impact on large and small employer plans and the individual plan market can be found here.

All health plans – whether or not they are grandfathered plans – must provide certain benefits to their customers for plan years starting on or after Sept. 23, 2010, including:

• No lifetime limits on coverage for all plans;
• No rescissions of coverage when people get sick and have previously made an unintentional mistake on their application; and
• Extension of parents' coverage to young adults under 26 years old.

According to HHS, for the vast majority of Americans who get their health insurance through employers, additional benefits will be offered, irrespective of whether their plan is grandfathered, including:

• No coverage exclusions for children with pre-existing conditions; and
• No "restricted" annual limits (e.g., annual dollar-amount limits on coverage below standards to be set in future regulations).

HHS states large employer-based plans already offer benefits and consumer protections defined within the Affordable Care Act, leaving more than 100 million Americans the chance to maintain their workplace coverage.

But for the 42 million insured through small businesses and the 17 million who are in the individual market, HHS reports they'll likely transition from their current plan to one they can purchase with the new Affordable Care Act protections over the next few years.

"Small plans tend to make substantial changes to cost sharing, employer contributions, and health insurance issuers more frequently than large plans," according to HHS. "To help small businesses afford employee coverage, the Affordable Care Act includes a tax credit for up to 35 percent of their premium contributions.

"In 2014, small businesses and individuals who purchase insurance on their own will gain access to the competitive market Exchanges. These Exchanges will offer individuals and workers in small businesses with a much greater choice of plans at more affordable rates – the same choice as members of Congress. In fact, the Congressional Budget Office (CBO) has estimated that, on an apples-to-apples basis, premiums will be 14- 20 percent lower than they would be under current law in 2016 due to competition, lower insurance overhead, and increased pooling and purchasing power. Small businesses also will have more affordable options. CBO has estimated that a family policy for small businesses would be available in the Exchanges at a premium that is $4,000 lower than under current law in 2016.

"These reduced premiums do not take into account the tax credits available to small businesses and middle class families to help make insurance affordable. These additional new choices and cost savings may further lower the likelihood that small businesses workers will remain in grandfathered health plans. Consumers insured through large employers are more likely to remain in grandfathered plans in 2014 and beyond."

A fact sheet about the regulation can be found here.

View the complete legislation here.