The United States department of Health and Human Services (HHS) has clarified information related to mandated coverage of “essential benefits” as defined by the Patient Protection and Affordable Care Act (PPACA), commonly known as “ObamaCare.” According to the mandate, daily, visit or dollar limits on specific essential benefits are prohibited. Read on for specifics!
Between 9/23/2010 and 9/23/2011, insurers are required to provide at least $750,000 in coverage for essential benefits. Insurers cannot apply an annual benefit limit on a specific essential benefit (for example, hospitalization can’t be capped at a certain amount). However, policies may contain an aggregate annual limit on all essential benefits in excess of $750,000.
Rehabilitation is defined by HHS as an essential benefit. Any service provided in conjunction with rehabilitation, such as durable medical equipment or residential care, cannot have a limit of any kind. Limitations may be established for services not related to rehabilitation, such as chronic conditions.
Insurers are not required to refile the approved PPACA forms until their next annual filing. However, your company is expected to provide coverage for essential benefits in compliance with the new HHS clarification.
Please let me know if you have any questions!