HHS Releases Guidance on Prohibition of Annual Limits

by Rebecca Farley on September 9, 2010

Under the Patient Protection and Affordable Care Act, annual limits on the value of insurance benefits will be prohibited beginning in 2014. The law calls for restrictions on annual limits beginning this month. Te Department of Health and Human Services (HHS) has released guidance on these restrictions, including a process by which insurance plans may receive a 1-year waiver from compliance with the requirements.

In June, HHS published an interim final rule outlining the allowable annual limits on the dollar value of health benefits. These limits cannot be lower than: $750,000 for plan years beginning Sept. 23, 2010 to Sept. 22, 2011; $1.25 million for plan years beginning Sept. 23, 2011 to Sept. 22, 2012; $2 million for plan years beginning Sept. 23, 2012 to Dec. 31, 2013; and are prohibited thereafter.

In its recent informational bulletin, HHS detailed the process by which plans may gain a 1-year exemption from these requirements. The guidance states that plans must prove that compliance “would result in a significant decrease in access to benefits or a significant increase in premiums.” The waiver option is available for only one year, and plans would have to reapply annually in accordance with future guidance from HHS.

The National Council has signed on to comments by the Coalition for Citizens with Disabilities in response to the IFR regulating annual limits. Click here to read our comments.

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