How to waive annual limit restrictions

The Department of Health and Human Services has issued guidance for health plans that want to waive restrictions on annual dollar limits for coverage.

The healthcare reform law limits health plans' annual caps for plans beginning on or after September 23, 2010 and prior to January 1, 2014. Yet these restrictions can be waived "if compliance with the interim final regulations would result in a significant decrease in access to benefits or a significant increase in premiums," said the HHS guidance.

The guidance only applies to plans beginning between September 23, 2010 and September 23, 2011. "The waiver is only valid for one year, and plans must reapply annually ‘in accordance with future guidance from HHS,'" reports the Healthwatch.

For plan years beginning between September 23, 2010 and September 23, 2011, plans must submit an application for waiver not less than 30 days before the start of the plan year. If plans begin before November 2, 2010, they must submit the waiver application not less than 10 days before the start of the plan year.

According to the guidance, the waiver application must include:

  • The terms of the plan;
  • The number of individuals covered;
  • The annual limit(s) and rates applicable;
  • A brief description of why the plan is seeking a waiver;
  • An attestation, signed by the plan administrator or CEO of the issuer of the coverage, certifying that the plan was in force prior to September 23, 2010 and the application of restricted annual limits would result in a significant decrease in access to benefits or a significant increase in premiums.

The Affordable Care Act will prohibit annual dollar limits for plans starting January 1, 2014, except for grandfathered individual market policies.

For more:
- read the HHS guidance
- read the Healthwatch blog post
- see the interim final rule in the Federal Register

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