Lifetime and Annual Limits

The (ACA) restructures annual and lifetime policy limits

Lifetime Limits

A group health plan may impose lifetime limits on the dollar value of specific covered benefits that are not “essential health benefits” to the extent that those limits are not otherwise prohibited under federal or state law.¬†Under health reform, lifetime and annual dollar limits for all policies will be eliminated in 2014. There also are gradual changes taking place before then.

Lifetime Limits Video

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Annual Limits

The provision restricts annual limits on the dollar value of Essential Health Benefits. Annual limits may not be less than the following amounts.

For plan years beginning before Jan. 1, 2014:

$750,000 on or after Sept. 23, 2010
$1.25 million on or after Sept. 23, 2011
$2 million on or after Sept. 23, 2012 to Jan. 1, 2014
These restricted annual limits apply on an individual-by-individual basis; however, they do not apply to individual health plans that are grandfathered.

For plan years beginning on or after Jan. 1, 2014, group health plans may not establish any annual dollar limits on essential health benefits.

Annual Limits Video

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