<nobr>Jun 20, 2011</nobr>

CMS Announces Deadline for Waiver Requests from Restrictions on Coverage Limits

The Centers for Medicare and Medicaid Services (CMS) on June 17 issued new guidance announcing that after September 22, 2011, it will no longer accept new applications for waivers of restrictions on annual coverage limits for limited benefit plans (aka, "mini-med" plans).

Under the Patient Protection and Accountable Care Act, insurers and plans must phase out the use of annual dollar limits on essential health benefits until annual dollar limits are banned for non-grandfathered plans beginning in 2014. Currently, most plans cannot impose an annual limit that is less than $750,000; that limit will increase to $1.25 million for plan years starting after September 23, 2011, and to $2 million for plan years starting after September 23, 2012.

HHS issued the original guidance on September 3, 2010, detailing the waiver process requiring plans to demonstrate that complying with a $750,000 annual limit would cause a significant increase in premiums or a significant decrease in access to benefits.

The new guidance issued in the form of a bulletin describes the conclusion of the waiver program for new applicants, and establishes a process for plans that have already received waivers and want to renew those waivers for plan or policy years beginning before January 1, 2014.

To access the guidance, click on the links below.

CMS Guidance Bulletin
http://cciio.cms.gov/resources/files/06162011_annual_limit_guidance_2011-2012_final.pdf

CMS Fact Sheet
http://www.healthcare.gov/news/factsheets/annuallimit06172011a.html

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