Annual limits
Summary
Under health reform, lifetime and annual dollar limits on the dollar value of Essential Health Benefits were eliminated in 2014.
Lifetime and Annual Limits Under the Affordable Care Act
Under health reform, lifetime and annual dollar limits for all policies were eliminated in 2014.
Video transcript
A man wearing glasses riffles through a book, plays with a pointer and a small set of scales, and talks inaudibly on a telephone. Classical music plays.
MAN: Welcome to "Healthcare Reform Demystified." Today's episode: Lifetime and Annual Limits Under the Affordable Care Act.
ON SCREEN TEXT: HEALTHCARE REFORM REFERENCE ROOM LIFETIME AND ANNUAL LIMITS UNDER THE AFFORDABLE CARE ACT
In a well-appointed library, the man sits at a desk straightening a ball cap on his head. He looks up suddenly and talks into the camera.
ON SCREEN TEXT: ANNUAL & LIFETIME LIMITS
MAN: Welcome. You'll forgive my manners for wearing a cap indoors. But since it's to help you learn more about changes to annual and lifetime limits on health insurance, I think you--and my mother--will forgive me. Now, most insurance companies have historically had annual and/or lifetime limits or...caps as part of their plans. These caps could be a dollar amount like...
He puts another ball cap over the one already on his head.
ON SCREEN TEXT: $$$$
MAN: A million dollars being the most a plan would pay for an individual's health costs while they're enrolled in that plan... or it could be a frequency cap...
He puts another ball cap over the one already on his head.
ON SCREEN TEXT: 30 VISITS
MAN: Such as only covering 30 visits to a chiropractor in a year. Under health reform, lifetime and annual dollar limits for all policies new and renewing will be eliminated in 2014.
He tosses the hats out of the frame and resumes talking.
MAN: There are several gradual changes taking place before then that you should know about. Most of these changes focus on what are called...
He flips a card from a pile in front of him. Black text is visible.
ON SCREEN TEXT: Essential Health Benefits
MAN: While it's yet to be determined exactly what that covers, it's pretty much what it says: health benefits that are essential. The law broadly defines essential health benefits as things like...
He flips cards one by one from the pile in front of him. Black drawings are visible: An ambulance, a hospital bed, three toy blocks, a prescription bottle, a stethoscope, and a syringe.
MAN: Emergency services, hospitalization, maternity and newborn care, prescription drugs, preventive and wellness services, and... chronic disease management, to name a few.
He flips another card from the pile. A photo of the man holding a large camera is visible.
MAN: Oops. Um... that's, uh, from my summer vacation. [softly] Hello! Hello, hello, hello... I don't know how that got in there.
In another shot, a trio of bald mannequin busts are revealed near a green chalkboard. One wears a "Lifetime limits" ball cap. Mellow jazzy music plays. The man stands behind the mannequins.
ON SCREEN TEXT: LIFETIME $ LIMITS
MAN: Now, what are those important, gradual changes that are happening? As of September 23, 2010, there are no lifetime dollar limits for essential health benefits. So, let's get rid of that.
He knocks the hat off the mannequin's head.
MAN: Similarly, since September 23, 2010, plans have been restricted in the ability to impose annual dollar limits on essential benefits.
He places a cap on another mannequin's head.
ON SCREEN TEXT: $1.25 MILLION UNTIL 9-23-12
MAN: Currently, the minimum annual dollar limit allowed for essential health benefits is $1.25 million per individual.
He places a cap on another mannequin's head.
ON SCREEN TEXT: $2 MILLION UNTIL 1-1-14
MAN: That amount will increase to $2 million per individual for plan years beginning September 23, 2012.
He removes a cap from another mannequin's head.
ON SCREEN TEXT: ANNUAL $ LIMITS
MAN: And beginning January 1, 2014, there will be no annual dollar limits allowed for essential health benefits. I greatly prefer taking the caps off.
White text appears on the green chalkboard. Mellow jazzy music plays.
ON SCREEN TEXT: Things to Remember About Changes to Lifetime and Annual Limits -Changes refer to dollar amounts -Allowable visits for essential health benefits may still be limited
MAN: Please keep in mind that these changes refer to dollar amounts. Even after 2014, there may still be some limits, such as the number of allowable visits per year that apply to essential health benefits.
ON SCREEN TEXT: -Dollar and frequency limits for non-essential health benefits may apply
MAN: And non-essential health benefits may still be subject to certain dollar or frequency limits.
The man reappears leaning on the mantel near a mannequin and talking to it.
MAN: And I said, "I'm just trying to get ahead." [chuckles] You get it? Oh...
He looks at the camera and continues talking.
MAN: Anyway, if you'd like to know more about the dollar limits on essential health benefits, check out the essential benefits provision where you can download the UnitedHealthcare guides to Essential Health Benefits for Fully Insured and Self-Funded Plans.
The image fades and white text appears on a black background.
ON SCREEN TEXT: UnitedHealthcare uhc.com/reform
MAN: You can find more answers to questions about the Affordable Care Act on the United For Reform website. And, as always, contact your broker or a UnitedHealthcare representative with any questions about your plan.
The man reappears leaning on the mantel near the mannequin and staring at it.
MAN: Ohh! You win. Okay--best two out of three. And...go.
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