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.

Expand All | Collapse All

Non-Grandfathered: If a group does not intend to retain grandfathered status, no additional action is required on their part. They may continue with their renewal process.

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

  • Coverage for accounts in the under 200 risk market already includes all PPACA mandated benefits and grandfathering will not remove these.
  • Groups must return a Notice of Intent with their renewal package.

CareFirst will not treat plans as grandfathered plans unless a completed Notice of Intent is returned to CareFirst with the group's renewal forms. In addition, if a group selects benefit changes or has 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 their designated intention to remain grandfathered in the Notice of Intent.

All groups 1-50, 200+ Risk, and ASO markets will receive information about grandfathering in their renewal package. They will also receive a "Notice of Intent" to maintain grandfathered status, or links to that Notice. The Notice of Intent must be completed, signed and returned with their renewal, or within 30 days of receipt if the renewal has already occurred.

Brokers for the 1-50 and 51-199 Risk market should assure that a completed Notice of Intent is returned to CareFirst if a group intends to stay grandfathered. Forms for these groups are included below. For all other market segments, groups have primary responsibility for completing the form, and links to samples of those segment Notices of Intent have been included below for your information.

1 - 50 and 51-199 Risk Groups Only

Group size will dictate the form that should be completed. 200+ Groups will have the forms in their renewal packages. Samples are included below for viewing only.

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

  • The Word version can be saved as an electronic copy, completed and printed.
  • The PDF version must be printed out and completed by hand.
  • A copy should be retained by the group for their records before sending in the forms.


1-100 Notice of Intent information
1-50 Notice of Intent Word PDF
51-199 Risk Notice of Intent Word PDF

All Other 200+ Groups

  • Notice of Intent forms for all larger groups (200+) were included with the renewal package and were customized for the specific group.
  • The forms below are SAMPLES only and CANNOT be used for any group.
  • If you need replacement forms for any group, contact your sales representative.


200+ Notice of Intent information
Groups 200+ Risk Sample
Groups 200+ ASO Sample

Expand All | Collapse All