All "new" health plans are required to cover these preventive health services without cost-sharing. Health plans that existed before March 23, 2010, the date the ACA was enacted, are considered "grandfathered." Grandfathered plans are not required to cover these preventive services. Once a plan makes significant changes, such as changing covered benefits or cost-sharing or several other factors, it loses its "grandfathered" status and becomes "un-grandfathered." Un-grandfathered plans are group health plans created after March 23, 2010, group health plans that have implemented significant benefit or plan design changes, or individual plans purchased after that date. All un-grandfathered private health plans must cover preventive health services without cost-sharing.