PPACA Regulations – Preexisting Exclusions, Lifetime & Annual Limits and More

PPACA Regulations – Preexisting Exclusions, Lifetime & Annual Limits and More

Federal Regulators released guidance on several new matters today.

1. DOL/IRS/HHS released new regulations: Patient Protection and Affordable Care Act: Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections

These interim final regulations define “essential health benefits” by cross-reference to section 1302(b) of the Affordable Care Act 8 and applicable regulations (which have not been released).

However, for those grandfathered plans, certain annual limits, called “restricted annual limits” may still be possible (check to see if you plan has any annual limits now before contemplating any changes as a result of the chart below). A carrier or group health plan may establish an annual limit on the dollar amount of benefits that are essential health benefits, provided the limit is no less than:

(i) For a plan year beginning on or after 9/23/2010, but before 9/23/2011: $750,000.
(ii) For a plan year beginning on or after 9/23/2011, but before 9/23/2012: 1,250,000.
(iii) For plan years beginning on or after 9/23/2012, but before January 1, 2014: $2,000,000.

Click here for the Federal Register’s PDF.

2. Today, the Department of Labor also released a new Patient’s Bill of Rights.

Fact Sheet: The Affordable Care Act’s New Patient’s Bill of Rights is available here.