Defining Essential Benefits Under PPACA

We continue to receive guidance regarding health care reform changes.  One of the biggest changes for plans that renew on October 1st and after is the changes in lifetime limits and annual dollar limits.

For most group health plans in Virginia and West Virginia, a lifetime unlimited maximum benefit already exists.  All plans have dollar limits on an annual basis for chiropractic services, outpatient speech, occupational, physical therapy and in some cases outpatient mental and nervous conditions.

The attach list from Anthem Blue Cross is an expectation of the essential health benefits being proposed by the Health and Human Services (HHS), the architect for health care reform.

Eliminating annual limits will have an impact on pricing.  Insurers have used annual limits as a way to lower health care costs, eliminate fraud and an attempt to keep costs at bay.  Any elimination of annual limits will increase benefits which will ultimately increase costs.

Remember, these changes have not been finalized and will not impact your health care plan until your plan renews on or after October 1st, 2010.  As always, we appreciate your business and your trust.  You can count on Muneris for comprehensive health care reform guidance.

Follow the link below to view how one carrier is complying with these parts of the new legislation:
Anthem – How we are complying with the health care reform law lifetime and annual dollar limits

Burman S. Clark

Burman S. Clark, RHU, CSA is the President of Muneris Benefits and a licensed insurance broker and consultant. His independent practice and focuses on employee benefits, individual life, disability, medical, and senior products. Burman has traveled extensively and provided guidance to large employer associations with regards to the Affordable Care Act.