Tag Archives: lifetime limits

The regulations in the Patient Protection and Affordable Care Act’s Patient’s Bill of Rights, which address preexisting condition exclusions, retroactive rescissions, lifetime limits, annual dollar limits and other consumer-protection mandates, aim to “put American consumers back in charge of their health coverage and care,” according to a healthreform.gov fact sheet.

However, after a week to digest the legislation’s interim final rules, EBA’s health reform panelists are left wanting more.

For Dave Lapka, president of logistics consulting company D360, the issue begins with the title.

“Interesting choice of titles: ‘Patient’s Bill of Rights.’ The definition of rights as applied in the U.S. Constitution represent things that the government can’t take away from states or citizens,” he says. “The term ‘rights’ in this application is really just a listing of minimally acceptable cost levels. It then includes the possibility of waivers, so that significant cost increases or coverage limitations don’t occur. So you might have changes or you might not — a bureaucrat will decide once the political winds are determined. If policies are ‘waive-able’ were they ever really rights?”

Lapka refers to a provision in the rules that allows for plans with an annual dollar limit, such as limited medical plans, to seek a waiver that would allow for a delay in compliance as long as the plan “can prove that its current annual limits are necessary to prevent a significant loss of coverage or increase in premiums,” according to a Hewitt overview. Continue reading →