HHS Releases Annual Health Coverage Limit Waiver Guidance

Steve Larsen, Director, Office of Oversight, U.S. Department of Health and Human Services (HHS), explained that the limited benefit or “mini-med” plans, often with annual caps well below those set out in interim final HHS rules issued in June, often offer lower-cost coverage to part-time workers, seasonal workers, and volunteers who otherwise may not be able to afford coverage at all.

To make sure people in those plans won’t be shut out from access to needed services or “experience more than a minimal impact on premiums,” HHS set up the waiver process for plan or policy years beginning prior to January 1, 2014.  

The health reform law includes provisions that for plan (or policy) years beginning on or after September 23, 2010, but before January 1, 2014, annual limits are restricted to certain levels specified in the regulations  As set out in the interim final regulations, the restricted annual limits on the dollar value of essential health benefits cannot be lower than:

• $750,000 for plan or policy years beginning on or after September 23, 2010, but before September 23, 2011;
• $1.25 million for plan or policy years beginning on or after September 23, 2011, but before September 23, 2012; and
• $2 million for plan or policy years beginning on or after September 23, 2012, but before January 1, 2014.

According to Larsen’s memo describing the waiver process, a group health plan or insurer may apply for a waiver for the plan or policy year beginning on or after September 23, 2010, and before September 23, 2011, if the plan or coverage was offered prior to September 23, 2010. Applications are required to be submitted not less than 30 days before the beginning of the plan or policy year (but if the plan or policy year begins before November 2, 2010, the application must be submitted not less than 10 days before the beginning of that year).

Waiver Application Content  

The waiver application has to include:

• the terms of the plan or policy,
• the number of individuals covered,
• the annual limits(s) and rates,
• a brief description of why compliance with the interim final regulations would result in a significant decrease in access to benefits or significant increase in premiums paid (along with supporting documentation), and
• an attestation certifying that the plan was in force prior to September 23, 2010, and that compliance would result in a significant decrease in access to benefits or significant increase in premiums paid.

HHS said it will process complete waiver applications within 30 days, except for applications submitted for plan or policy years beginning before November 2, 2010, that will be processed no later than five days ahead of such plan or policy year.

The waivers can be sent to HHS, Office of Consumer Information and Insurance Oversight, Office of Oversight, attention James Mayhew, Room 737-F-04, 200 Independence Ave. SW, Washington, DC 20201 or by email to healthinsurance@hhs.gov (use “waiver” as the subject of the email).

Waiver questions can be directed to the HHS Office of Consumer Information and Insurance Oversight at (301) 492 4100 or email at healthinsurance@hhs.gov (use “waiver” as the subject of the email). 

The waiver guidance is at http://www.hhs.gov/ociio/regulations/patient/ociio_2010-1_20100903_508.pdf.