The Affordable Care Act is designed to provide Americans with affordable, high-quality coverage options – while ensuring that those who like their current coverage can keep it. Unfortunately, today, limited benefit plans, or “mini-med” plans are often the only type of insurance offered to some workers. In 2014, the Affordable Care Act will end mini-med plans when Americans will have better access to affordable, comprehensive health insurance plans that cannot use high deductibles or annual limits to limit benefits. In the meantime, the law requires insurers to phase out the use of annual dollar limits on benefits. In 2011, most plans can impose an annual limit of no less than $750,000. Mini-med plans have lower limits than allowed under the Affordable Care Act. While mini- med plans do not provide security in the event of serious illness or accident, they are unfortunately the only option that some employers offer. In order to protect coverage for these workers, the Affordable Care Act allows these plans to apply for temporary waivers from rules restricting the size of annual limits to some group health plans and health insurance issuers.
Waivers only last for one year and are only available if the plan certifies that a waiver is necessary to prevent either a large increase in premiums or a significant decrease in access to coverage. In addition, enrollees must be informed that their plan does not meet the requirements of the Affordable Care Act. No other provision of the Affordable Care Act is affected by these waivers: they only apply to the annual limit policy.
As of today, a total of 733 waivers have been granted for 2011. Key facts about annual limits waivers: There was an increase in the number of applications received at the end of 2010 because December 1 was the final day to apply for a waiver for a plan or policy year that begins on January 1 – as many plans do. Over 500 waivers were granted in December. While the number of approved waivers increased by more than 200 percent, the total number of enrollees in plans receiving waivers has increased by only 48 percent since the previous posting. Of all the waivers granted to date: Employment-Based Coverage: The vast majority – 712 plans representing 97 percent of all waivers – were granted to health plans that are employment-related. Self-Insured Employer Plans Applicants: Employer-based health plans received most of the waivers – 359. Collectively-Bargained Employer-Based Plan Applicants: Most of the other health plans receiving waivers are multi-employer health funds created by a collective bargaining agreement between a union and two or more employers, pursuant to the Taft-Hartley Act. These “union plans” are employment based group health plans and operate for the sole benefit of workers. They tend to be larger than other typical group health plans because they cover multiple employers. There are also single-employer union plans that have received a waiver. In total, 182 collectively-bargained plans have received waivers. Health Reimbursement Arrangements (HRAs): HRAs are employer-funded group health plans where employees are reimbursed tax-free for qualified medical expenses up to a maximum dollar amount for a coverage period. In total, HHS has approved 171 applications for waivers for HRAs. Health Insurers: Sixteen waivers were granted to health insurers, which can apply for a waiver for multiple mini-med products sold to employers or individuals. State Governments: Four waivers have gone to State governments. States may apply for a waiver of the restricted annual limits on behalf of issuers of state-mandated policies if state law required the policies to be offered by the issuers prior to September 23, 2010. The number of enrollees in plans with annual limits waivers is 2.1 million, representing only about 1 percent of all Americans who have private health insurance today.
Improving Transparency
HHS periodically posts the list of the plans that have been granted waivers to ensure the public is aware of the waiver process and stakeholders understand how they are affected. Also, on December 9, 2010 HHS issued new rules requiring that health insurers offering mini-med plans must notify consumers in plain language that their plan offers extremely limited benefits and direct them to www.HealthCare.gov where they can get more information about other coverage options. The rules require health plans with waivers to tell consumers if their health care coverage is subject to an annual dollar limit lower than what is required under the law. This way, enrollees know when their coverage is limited.
Annual limits waivers are temporary. In 2014 annual dollar limits will be prohibited and mini-med plans will no longer be necessary.
Approved Applications for Waiver of the Annual Limits Requirements
Updated January 26, 2011
All Applicants Listed have had 1 or more plans/policies approved.
Approved State applicants are listed separately below
Applications for waivers from annual limit requirements are reviewed on a case by case basis by Department officials who look at a series of factors including whether or not a premium increase is large or if a significant number of enrollees would lose access to their current plan because the coverage would not be offered in the absence of a waiver. More detailed information on specific criteria can be found at: www.hhs.gov/ociio/regulations/11- 05-2010annual_limits_waiver_bulletin.pdf. Approved applicants are granted an annual limit waiver for one year. The Office of Consumer Information and Insurance Oversight’s sub- regulatory guidance on the process for obtaining waivers of the annual limits requirements may be found at: www.hhs.gov/ociio/regulations/patient/ociio_2010- 1_20100903_508.pdf
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