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I thought the HCR prohibited annual & lifetieme caps? WTF

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Statistical Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-24-10 07:13 AM
Original message
I thought the HCR prohibited annual & lifetieme caps? WTF
Edited on Wed Mar-24-10 07:33 AM by Statistical
On CNN (I listen on my commute) they had Dr. G on. He was answering questions emailed in about HCR.

One was about lifetime cap on existing policies. He said they will go away on existing policies in 6 months.
However he said the law allows insurance companies to replace lifetime cap with annual caps.

WTF? Anyone have a link or cite?
Did he forget to take his meds or did the Dems really screw that one up?

I mean my current policy has a $5 mil lifetime max but no annual max. If they replace lifetime max with an annual max of say $200,000 IMHO I am worse off.
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kaiden Donating Member (811 posts) Send PM | Profile | Ignore Wed Mar-24-10 07:14 AM
Response to Original message
1. I understood that there are no annual caps either.
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tekisui Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-24-10 07:16 AM
Response to Original message
2. I was under the impression there were caps on both.
Someone will answer definitively shortly, I am sure.
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canoeist52 Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-24-10 07:17 AM
Response to Original message
3. The doctor is correct. One of Aetna's policies has a 50,000 annual cap right now.
Edited on Wed Mar-24-10 07:22 AM by canoeist52
My understanding is that the annual caps go away in 4 yrs.
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PA Democrat Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-24-10 07:21 AM
Response to Original message
4. The doctor was right. Here is a link and the actual language.
http://blogs.consumerreports.org/health/2009/12/healthc...

But as the Associated Press reported, the Senate bill, as currently written, would allow insurance companies to do exactly that. Take, for instance, the fine print on page 16 of the Senate bill under Subpart IIImproving Coverage (weve added boldface to highlight problem areas):

(a) IN GENERAL.A group health plan and a health-insurance issuer offering group or individual health insurance coverage may not establish(1) lifetime limits on the dollar value of benefits for any participant or beneficiary; or (2) unreasonable annual limits (within the meaning of section 223 of the Internal Revenue Code of 1986) on the dollar value of benefits for any participant or beneficiary."

Apparently, according to this clause, insurers can set reasonable annual caps on coverage, just not unreasonable ones. But whats a reasonable limit? The bill doesnt say.

And thats not the only problem with this text. See where it says dollar value? This is a loophole that would let insurers limit certain types of care, such as physical rehabilitation sessions or mental-health counseling.

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Warren Stupidity Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-24-10 07:23 AM
Response to Reply #4
6. annual caps end 2014.
And they have to be reasonable until then. Is this perfect? No. Is it better than what we have now? Yes it is.
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Statistical Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-24-10 07:27 AM
Response to Reply #4
8. So a lot depends on what is "unreasonable annual limits".
Edited on Wed Mar-24-10 07:27 AM by Statistical
I mean is $200,000 annual limit "unreasonable"? Is $50,000?

It could be only slightly bad or it could be really bad depending on what is unreasonable.

I imagine there is a massive amount of lobbying going on right now to make the "unreasonable annual limits" defined as low as possible.
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Statistical Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-24-10 07:42 AM
Response to Reply #4
9. Found the exact text in the version of bill signed into law.
Edited on Wed Mar-24-10 07:52 AM by Statistical
SEC. 2711. NO LIFETIME OR ANNUAL LIMITS.

`(a) Prohibition-

`(1) IN GENERAL- A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish--

`(A) lifetime limits on the dollar value of benefits for any participant or beneficiary; or

`(B) except as provided in paragraph (2), annual limits on the dollar value of benefits for any participant or beneficiary.

`(2) ANNUAL LIMITS PRIOR TO 2014- With respect to plan years beginning prior to January 1, 2014, a group health plan and a health insurance issuer offering group or individual health insurance coverage may only establish a restricted annual limit on the dollar value of benefits for any participant or beneficiary with respect to the scope of benefits that are essential health benefits under section 1302(b) of the Patient Protection and Affordable Care Act, as determined by the Secretary. In defining the term `restricted annual limit' for purposes of the preceding sentence, the Secretary shall ensure that access to needed services is made available with a minimal impact on premiums.


So looks like it isn't that bad. The wording was improved from original senate version.
http://thomas.loc.gov/cgi-bin/query/z?c111:h3590.enr:
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OmmmSweetOmmm Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-24-10 07:48 AM
Response to Reply #9
10. The link isn't working. I'm actually looking into what I've heard about a $100 day fine
if an insurance company refuses someone with a pre-existing condition.
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Statistical Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-24-10 07:51 AM
Response to Reply #10
11. Yeah I am sorry about that. DU keeps converting the link into smiley.
I found another link and update post.
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OmmmSweetOmmm Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-24-10 07:54 AM
Response to Reply #11
12. Thank you! :)
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Warren Stupidity Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-24-10 07:22 AM
Response to Original message
5. 2014
Eliminate lifetime caps on benefits for all insurance plans 6 months after enactment of the bill;
Eliminate annual caps on benefits for individual and group plans in 2014;

Annual caps can remain until then, but are restricted. There are also caps on your out of pocket expenses.
You are not worse off.
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Statistical Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-24-10 07:25 AM
Response to Reply #5
7. You have a link or cite because the link above says nothing about 2014?
Edited on Wed Mar-24-10 07:43 AM by Statistical
On edit: Your were right. See #9 above for exact text & link.

I guess the confusion comes from fact that there were so many revisions. The text I linked to was version signed by President.
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