Patient Protections (Limits, preex, rescissions)

Government Resources
Analysis

Government Resources

Under The Affordable Care Act, 105 Million Americans No Longer Face Lifetime Limits on Health Benefits, 3/6/12 (New)

Questions and Answers Related to Annual Limit Waivers, 2/10/12 

The U.S. Center for Consumer Information & Insurance Oversight (CCIIO) has issued guidance with respect to the application of the existing annual limit waiver criteria to Health Reimbursement Arrangements (HRAs). This supplemental guidance exempts HRAs that are subject to the restricted annual limits as a class from having to apply individually for an annual limit waiver. 8/19/11  

CMS has released guidance on the waivers from the annual limits provision of the ACA. After September 22, 2011, no new applications or requests for temporary waivers extensions will be considered for plans that demonstrate that compliance with the phase-out of limits would result in a significant decrease in access to benefits or a significant increase in premiums. Additionally, any plans receiving these waivers will have to alert consumers that the plan has restrictive coverage, including low annual limits that could result in high out-of-pocket spending if you need hospital or other high-cost services.

• Guidance, 6/17/11  
• Fact Sheet, 6/17/11  
• News Release, 6/17/11  

Private Health Insurance: Waivers of Restrictions on Annual Limits on Health Benefits, Government Accountability Office (GAO), 6/14/11  

Approved Applications for Waiver of the Annual Limits Requirements, (Updated regularly)    

HHS's OCIIO has released new guidance that will give consumers more information about their health insurance plan. Under the new rules, health insurers offering “mini-med” plans must notify consumers in plain language that their plan offers extremely limited benefits and direct them to www.HealthCare.gov where they can get more information about other coverage options. HHS has also issued guidance restricting the sale of new mini-med plans except under very limited circumstances.

• Press Release, 12/9/10
• Additional Guidance on Mini-Med Plan Notifications, 12/9/10 
• Application Form and Instructions, 12/9/10
• Fact Sheet, 12/9/10  

The OCIIO has issued additional guidance to clarify the waiver process. This guidance addresses who can apply for a waiver and whether some similar process might be available with respect to the medical loss ratio (MLR) provisions of the Affordable Care Act with respect to mini-med plans.

• Supplemental Guidance, 11/5/10    

The OCIIO has released guidance on obtaining a waiver of the restricted annual limits required by the health care reform law. The regulations on annual limits provided that these restrictions may be waived by the Secretary of Health and Human Services if compliance with the interim final regulations would result in a significant decrease in access to benefits or a significant increase in premiums. This guidance is especially relevant to limited benefit/mini-med plans.

• OCIIO Sub-Regulatory Guidance (OCIIO Bulletin 2010 - 1): Process for Obtaining Waivers of the Annual Limits Requirements of PHS Act Section 2711, 9/3/10  

The EBSA, IRS and OCIIO have released interim final rules to implement the health care reform provisions related to preexisting condition exclusions, lifetime and annual limits, rescissions, and patient protections. These regulations are effective on August 27, 2010. Public comments on the regulations will be accepted until August 27, 2010 as well.

• Questions and Answers on Enrollment of Children Under 19 Under the New Policy That Prohibits Pre-Existing Condition Exclusions, 7/27/10 
• Interim Final Rules, 6/22/10 
• Notice of Proposed Rulemaking by Cross-Reference to Temporary Regulations, 6/28/10 
• Model Notice on Patient Protections, 6/28/10 
  • Spanish version
• Model Notice on Lifetime Limits No Longer Applying and Enrollment Opportunity, 6/28/10
  • Spanish version  
• Fact Sheet,"The Affordable Care Act’s New Patient’s Bill of Rights," 6/22/10 
  
  

Analysis

• Stand-Alone HRAs Receive Exemption from Annual Limit Waiver Requirement, Buck Consultants, 10/13/11  
• Health Care Reform Update: HHS Annual Limit Waiver Program Will Close on September 22, 2011; No Waiver Application Required for Certain HRAs, Alston & Bird, 8/22/11  
• Annual Limit Waiver Process Ending; Plans May Apply for Extensions of Existing Waivers, Segal, 6/22/11  
• Revised Waiver Application Process, Proskauer Rose, 6/20/11  
• HHS Issues Additional Guidance on Mini-Med Health Plans, Buck Consultants, 12/21/10 
• Additional Guidance on the Annual Limit Waiver Process, Segal, 12/3/10 
• Subregulatory Guidance Issued on Annual Limit Waivers and MLR for Mini-Med Policies, Aon Hewitt, 11/11/10 
• New Cost-Sharing Limits, Deloitte, 11/10/11
• HHS Sets Out Process for Requesting Waiver of the Annual Dollar Limit Requirements under PPACA, Buck Consultants, 9/17/10 
• Guidance on Annual Limit Waivers Released, Sibson/Segal, 9/8/10 
• HHS Releases Guidance on Annual Dollar Limit Waivers, Hewitt, 9/8/10 
• Health Reform Ends Lifetime Limits and Trims Annual Caps, Mercer, 8/11/10 
• IRS, DOL, & HHS Issue Interim Final Regulations on Annual and Lifetime Coverage Limits, Preexisting Condition Exclusions, Coverage Rescission, Emergency Coverage, and Provider Selection, Michael Best & Freidrich, 7/6/10 
• More Health Reform Guidance – on Preexisting Condition Exclusions, Dollar Limits, Rescissions and Patient Protections, Buck Consultants, 7/2/10 
• Departments Issue Core Interim Regulations, Alston & Bird, 6/29/10 
• Agencies Issue Regulations On Pre-existing Condition Exclusions, Annual & Lifetime Limits, Rescission, & Patient Protections, Groom Law Group, 6/29/10 
• Health Care Reform: Interim Final Regulations Released for Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections, Proskauer Rose, 6/28/10   
• Agencies Issue Regulations Implementing Health Care Reform "Patient's Bill of Rights," Hewitt, 6/23/10