Health and Human Services (HHS) issued supplemental guidance providing model language that group health plans and health insurers (generally of “mini-med” plans) will be required to use to notify plan participants if the plan or insurer has received a waiver of the annual limits requirements in the Affordable Care Act (ACA). In addition to providing model language, the HHS guidance also specifies when the notice must be provided (within the next 60 days for plans and insurers that have already received the waiver) and that the notice must be prominently displayed in 14-point bold type on the front of plan informational materials and documents. The model notice is reproduced in full below and is available at http://www.healthcare.gov/center/regulations/guidance_limited_benefit_2nd_supp_bulletin_120910.pdf
“Limited benefit” plans or “mini med” plans usually have annual limits well below these new restricted annual limits. Since these “mini-med” plans offer lower-cost coverage to part-time workers, seasonal workers, and volunteers who otherwise may not be able to afford other coverage, or may not be eligible for other coverage, HHS in prior guidance established a waiver process under which “mini-med” plans and issuers can (annually) request a waiver from the annual limits listed above. One of the conditions of receiving a waiver from the annual limits requirements is that the group health plan or health insurance issuer must provide a notice informing current and eligible participants and subscribers that the plan or policy does not meet the minimum annual limits for essential benefits and has received a waiver of the requirement. The model language published today by HHS may be used to satisfy this notice requirement.
Additional Information about the Model Language
- The model language must be prominently displayed in clear, conspicuous 14-point bold type on the front of plan informational and educational materials (such as summary plan descriptions) or plan documents that are sent to participants.
- As specified in prior HHS guidance, the model language requires the plan or issuer to specify the dollar amount of the plan’s or policy’s annual limit (e.g., $5,000 rather than $750,000) plus a description of the plan benefits to which the limit applies.
- It also states that the waiver was granted for only one year (again, as required in prior HHS guidance).
- The model notice also requires the plan or issuer to include contact information for the plan administrator or health insurance issuer, in case the participant has questions.
The HHS guidance also specifies when the model notice must be provided to current and eligible participants:
- For plan or policy years that begin before February 1, 2011, and that have already recieved a waiver or will receive a waiver, the notice must be provided to eligible participants and subscribers within 60 days of the date this guidance is issued (i.e., by February 11, 2011)
- For plan or policy years that begin on or after February 1, 2011, the notice must be provided to eligible participants and subscribers as part of any informational or educational materials, and also in any plan or policy documents evidencing coverage that are sent to enrollees (e.g., summary plan descriptions).
If you have any questions regarding the HHS supplemental guidance, you can e-mail the OCIIO mailbox at OCIIOOversight@hhs.gov (use “supplemental guidance” in the subject line).
The Model Notice is as follows:
The Affordable Care Act prohibits health plans from applying arbitrary dollar limits for coverage for key benefits. This year, if a plan applies a dollar limit on the coverage it provides for key benefits in a year, that limit must be at least $750,000.
Your health insurance coverage, offered by [name of group health plan or health insurance issuer], does not meet the minimum standards required by the Affordable Care Act described above. Instead, it puts an annual limit of:
[dollar amount] on [all covered benefits]
[dollar amount(s)] on [which covered benefits – notice should describe all annual limits that apply].
In order to apply the lower limits described above, your health plan requested a waiver of the requirement that coverage for key benefits be at least $750,000 this year. That waiver was granted by the U.S. Department of Health and Human Services based on your health plan’s representation that providing $750,000 in coverage for key benefits this year would result in a significant increase in your premiums or a significant decrease in your access to benefits. This waiver is valid for one year.
If the lower limits are a concern, there may be other options for health care coverage available to you and your family members. For more information, go to: http://www.healthcare.gov/.
If you have any questions or concerns about this notice, contact [provide contact information for plan administrator or health insurance issuer].
[For plans offered in States with a Consumer Assistance Program] In addition, you can contact [contact information for consumer assistance program].