Health reform at 6 months: The sun sets on lifetime dollar limits for care

National health reform turns six months old on Sept. 23, when a variety of new rules and regulations take effect. In this weeklong series, we highlight how benefits will change for consumers in the near term. You can also find videos, news alerts, RSS feeds and other information at our health reform website.

Lifetime dollar limits on care will go the way of the 8-track tape, pinball machine and floppy disk when the federal health care reform law hits the six-month mark.

The Patient Protection and Affordable Care Act bans lifetime dollar limits for what it deems “essential health benefits” effective Sept. 23. The prohibition applies to all health plans, new or grandfathered, for plan years that begin on or after that date.

If you previously reached a lifetime dollar limit, your health plan will be required to offer you re-enrollment during a special 30-day open enrollment period, most likely later this year.

Blue Cross Blue Shield of Michigan and Blue Care Network will hold its special open enrollment period from Nov. 1 through Nov. 30. The coverage-effective date is Jan. 1, 2011, with the exception of groups that have a plan year that begins between Sept. 23 and Dec. 31. In this case, the coverage-effective date is the plan year start date.

Here are additional details of this provision:

  • The regulation does not apply to individuals who reached a lifetime dollar limit while covered by a contract that was not renewed or is no longer in effect.
  • It does apply to family members who lost coverage due to reaching a lifetime dollar limit if other members of the family are still covered by an active policy.
  • Plans must notify affected individuals how and when they are eligible to re-enroll.
  • The open enrollment period must occur no later than the first day of the first plan year beginning on or after Sept. 23. Coverage must start according to the same timeline.

The measure is part of the new “Patient’s Bill of Rights” created by the reform law.

About Shannon Paul
Social Media Strategist at Fifth Third Bank. This is a personal profile. Comments and activity are personal and do not represent my employer.

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