04/12/2011
Annual dollar limits for medical benefits removed from Individual plans
In December 2010, we told you about the new federal health care reform law requiring health plans to remove annual dollar limits on covered services deemed essential by the U.S. Department of Health and Human Services (HHS). At that time, we requested a waiver from the annual dollar-limit requirement for our Individual Regence Evolve plans.
We recently replaced the rehabilitation dollar limit with a day-visit limitation on our Individual Evolve plans. This is important, because it makes our rehabilitation limits now consistent with coverage offered by some other carriers.
We also modified our waiver request to include only a prescription drug benefit limitation, which is also consistent with the waiver requests of some other Washington carriers. We'll provide you with an update on the waiver as soon as we receive information from HHS.
To align with our group plans, we're treating all benefits on our Individual plans—except dental and vision—as essential benefits. As described above, we're not including pharmacy benefits subject to the pending waiver request.
A small number of claims have been impacted by these changes, and we're working to reprocess them. For members whose coverage became effective prior to Oct. 1, 2010, we're making these changes retroactive to Jan. 1, 2011. For members whose coverage became effective on or after Oct. 1, 2010, we're making these changes retroactive to their effective date. Mailings to impacted members will begin shortly:
- Member Letters with Endorsements will be sent to members who were new from Oct. 1, 2010 through Dec. 1, 2010, discontinued from the closed plans, or new, effective Jan. 1, 2011 onwards. These members have already received contracts with other health care reform updates and therefore only need the endorsement.
- Member Letters with Contracts will go to members who were new from Mar. 1, 2010 through Sep. 1, 2010 and have not yet received their Jan. 1, 2011 contract. We are combining the mailing of their contract with the endorsement.
We've implemented a $2 million annual maximum on essential benefits, which is aligned with federal minimum requirements that take effect October 2012. Implementing the 2012 minimum now will improve (1) benefit continuity for our members and (2) administrative efficiency by avoiding the need to update plans annually to keep up with increasing federal minimum requirements. As you know, annual dollar limits on essential benefits are prohibited altogether beginning in 2014.
We've updated our FAQ to reflect the benefit changes to our Individual plans.
We hope that this information provides you with basic information about these changes and how they will be implemented for your clients.
If you have any questions please call your Individual Sales Executive or Individual and Medicare Sales Producer Support at 1 (800) 557-0555.
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