On January 1, 2014, annual dollar limits set by health plans will be gone. Leading up to that date, health plans will gradually increase their annual dollar limits on "essential benefits". Essential benefits are things like hospital services, maternity care and prescription drugs.
Here's what's different
In the past, health plans could put a limit on how much your plan would pay in any one year. This annual dollar limit is being phased out and will be gone by 2014. So your coverage won't run out if you have a bad year.*
How it impacts you
If you have a serious health problem in a given year, you don't have to worry about whether your plan will pay for the mounting cost for care. Until they're phased out, here's a closer look at the annual dollar limits that plans can set:
- $2 million for plan/policy years beginning on or after September 23, 2012
- No annual dollar limits are allowed on most covered benefits beginning January 1, 2014.
I'm going to be having a baby. Can my health plan apply an annual dollar limit on maternity care?
No. The law protects limits on maternity care because it is an "essential benefit". Other essential benefits under the law include:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
Can my health plan apply an annual dollar limit on dental benefits?
Yes. Under the law, adult dental care is a "non-essential benefit".
Is there a reform law that applies to lifetime dollar limits?
Yes. Learn more about lifetime dollar limits.
* Have health insurance under a grandfathered plan? If so, you might not get these benefits. If there is any difference between the information on this website and your health plan, your policy's provisions will apply.