Elimination of Annual Limits on Coverage


Purpose:

To prohibit insured and self-funded health plans from imposing a maximum amount of health care expenses that the plan will pay out during a year for a covered individual


Intent:

To assure individuals that the health plan they are covered by will provide the coverage promised regardless of the amount of time the individual is covered or the total claims submitted by the individual while covered during a specific year


Related Provision:

Elimination of Lifetime Limits on Coverage


Health Plans Affected by this Provision:


Year Effective: 2010 (phased in through 2013), fully effective 2014
Medical Plan: Yes
Dental/Vision Plan: No, if stand-alone benefit excepted from HIPAA’s portability provisions
HRA: Yes, unless benefit excepted from HIPAA’s portability provisions or integrated with medical plan
Health Care FSA: No, if FSA is a stand-alone benefit excepted from HIPAA's portability provisions

Document Downloads:


Document Title Last Updated
Elimination of Annual Limits on Coverage Flyer  
IRS FAQ Prohibits Paying for Individual Medical Plans, May 19, 2014 04/19/2014
ACA Implementation Part XIX FAQs, May 2, 2014 05/02/2014
DOL Technical Release 2013-03 (HRAs) 03/01/2013
DOL, HHS, Treasury Dept. FAQs, January 2013 01/01/2013
CMS HRA Waiver Bulletin, August 2011 08/01/2011
Location (map)
1350 Deming Way, Ste 300
Middleton, WI 53562-4640

Mail Address
PO Box 44347
Madison, WI 53744-4347