How 2010 changes may impact you
Health Care Reform
Lifetime limits
Lifetime limits on the dollar value of essential benefits are now prohibited. This provision clarifies that nothing restricts the use of lifetime dollar limits for covered benefits that are not essential benefits. [Section 2711 of H.R. 3590/Section 2301 of H.R. 4872]Some Insurance Companies have "Grandfathered Plans"
Individual Yes
Insured Group Yes
Self-Funded Group Yes
Non-Grandfathered Plans
Individual Yes
Insured Group Yes
Self-Funded Group Yes
What most insurance companies are doing: Removal of lifetime limits from all plans, upon the next effective date or renewal date on or after Sept. 23, 2010. Check with your insurance companyAnnual maximums
Annual dollar limits are prohibited, except it allows for “restricted” annual dollar limits for essential benefits for plans years beginning prior to January 1, 2014. The regulations allow gradually increasing annual limits ($750,000 for plan year 2011; $1.25 million for plan year 2012; and $2 million for plan year 2013) until the limits are eliminated completely in 2014. It also clarifies that nothing restricts the use of annual dollar limits for covered benefits that are not essential benefits. [Section 2711 of H.R. 3590/Section 2301 of H.R. 4872]
Check with your insurance company for status of grandfathered vs. non grandfathered plans. The regulations establish restricted annual limits that increase until they are eliminated completely in 2014. HHS has agreed to waive the restricted annual benefit limit provisions in PPACA for qualified limited benefits plans until 2014, and we moved quickly to submit the necessary documentation to HHS to obtain waivers to preserve coverage for our limited benefits plan customers.
With the passage of the Patient Protection and Affordable Care Act (PPACA) in March 2010, the nation is moving closer to providing all Americans with access to health care coverage. The new health care reform law includes numerous individual and group comprehensive, major medical insurance market reform provisions that, for the most part, take effect in 2014 or later. Other provisions that are more in line with mandated benefits changes, rather than comprehensive reform, begin to become effective Sept. 23, 2010.
Rescissions and cancellations of coverage
Rescission are prohibited, except for fraud or intentional misrepresentation of material fact. It requires prior notice to the enrollee for cancellations. [Section 2712 of H.R. 3590/Section 2301 of H.R. 4872]Some Insurance Companies have "Grandfathered Plans"
Grandfathered Plans
Individual Yes
Insured Group Yes
Self-Funded Group Yes
Non-Grandfathered Plans
Individual Yes
Insured Group Yes
Self-Funded Group Yes
Check with your insurance company for status of grandfathered vs. non grandfathered plans