Obamacare News Blog

Anthem to remove lifetime maximum limits on all plans

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 and Questions

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Comment from John W Johnson on October 09, 2013

If the “No Lifetime Maximum Limit” became effective on 23 Sep 2010 why am I being dropped from Anthem BC/BS after reaching $65,000 in June 2013 when the amounts stated are as follows:  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. My termination from Anthem is effective on 31 Oct 2013. Would like an answer ASAP.

MEDICOVERAGE AGENT RESPONSE
John,
Thanks so much for your very serious question. Unfortunately, we are unable answer specific policy questions on this blog. Instead, we suggest that you contact the number on the back of your card to speak with Anthem staff directly. There should be a formal review process by the insurance provider. Best of luck.
-Kelly at Medicoverage.com



Comment from 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



Comment from 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?



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