Anthem to remove lifetime maximum limits on all plans
August 21, 2010
By James Wilson Jones
Anthem Blue Cross announced today that it has begun the process to remove lifetime maximum payouts to its health insurance plans. The recent health care reform legislation states that insurance plans can no longer have lifetime and annual dollar limits on “essential health benefits” as soon as September 23, 2010.
Since the U.S. Department of Health and Human Services (HHS) has yet to clarify its definition of “essential health benefits,” Anthem Blue Cross has come up with the following list of the services they believe will be affected:
- Alcoholism-related services
- Ambulance services
- Asthma education
- Bariatric surgery
- Chiropractic manipulation and osteopathic manipulation services
- Diabetic supplies
- Diagnostic services
- Durable medical equipment
- Enteral formula and food products
- Hearing aids
- Home health care
- Hospice
- Infusion therapy
- Kidney disease treatment
- Mental health/substance abuse
- Ostomy supplies
- Outpatient occupational therapy
- Outpatient physical therapy
- Outpatient speech therapy
- Pharmacy
- Physician office visit (diagnostic services)
- Preventive services
- Prosthetic devices/limbs
- Skilled nursing services
- Prosthetic devices/limbs
- Skilled nursing services
- Transplant services
- Treatment of temporomandibular joint disorder (TMJD or TMJ)
Anthem states that the listed services still may be subject to copays and other cost shares and will be phased in over time. Annual dollar limits of at least $750,000 will be allowed for plan years from September 23, 2010, to September 23, 2011. Annual dollar limits of at least $1.25 million will be allowed for plan years from September 23, 2011, to September 23, 2012.Annual dollar limits of at least $2 million will be allowed for plan years from September 23, 2012, to January 1, 2014. After January 2014 there will be no lifetime limits and annual dollar limits.
Comments for
Anthem to remove lifetime maximum limits on all plans
By ray Chavez on September 09, 2010
So what happens if you currently have a plan (before september 23)? Are they going to give us the same benefits and more importantly are our prices going to change?
By Jason W Jones on September 09, 2010
That is a good question. It is unclear what is going to happen to existing members. The information sent out isn’t clear on that point but it looks as though people who have existing plans will be able to keep their old coverage with their old benefits. This will be called “grandfathered status.” No word on if the price will change after their new benefits are in place. We will definitely update when we get more info
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