Protection for Consumers with ‘Limited Benefit” Insurance Policies

by Stacey Larson on December 29, 2010

Some consumers may soon receive notices from their employers or insurers informing them that their health plans fall short of meeting standards required by the Affordable Care Act. Specifically, those consumers with limited-benefit plans, which place caps on coverage for medical care, will be receiving the notices.  The Affordable Care Act bans annual limits entirely starting in 2014, but until then the current limit is $750,000 annually. However, some limited-benefit plans can cap coverage for medical care to as little as $2,000.

The Department of Health and Human Services indicates that employers and insurers have 60 days to send out detailed notices to consumers on the limitations of their health insurance policies. These notices must provide information as to the difference between the annual limit of the current plan and that required by the ACA. Notices must also provide information pertaining to other financial limits in the policies, such as restrictions on the amount of physician office care or hospitalization coverage. This information, contained in the letters and enrollment materials sent by insurers and employers to consumers, should help people understand the limits of their policies, as well as to possibly research policies with broader coverage.

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{ 1 comment… read it below or add one }

Ellen M. Adelman PhD January 21, 2011 at 9:29 am

People need to be better informed about mental health coverage that does not cover Serious Mental Illness. For example some -one with Bi-Polar disease could be denied coverage if that is their diagnosis.
This places the provider in a terrible predicament. Of-course the “ethical” course is to turn the patient away(not change their diagnosis), unless they can afford to pay privately.
Many folks with these diagnoses cannot afford to pay privately, and many of them need more care, because they are at greater risk for self-harm or harm to others. Are their any regulations in the new law that address this issue?


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