NCPA - National Center for Policy Analysis

Waivers of Restrictions on Annual Limits on Health Benefits

June 21, 2011

A new Government Accountability Office (GAO) report found that the Centers for Medicare and Medicaid Services' Center for Consumer Information and Insurance Oversight (CCIIO) has tended to approve waivers on annual limits to health plans in applications that projected a premium increase of 10 percent or more, says Modern Health Care.

Although the Patient Protection and Affordable Care Act bars health insurers and group plans from imposing annual dollar limits on essential benefits starting in January 2014, the law allows restricted benefits until then, and gives the Health and Human Services secretary the authority to define what those are.  Applications that requested waivers for multiple plans could receive approval for some plans and not others, the GAO said.

  • According to the report, CCIIO received a total of 1,415 applications for waivers as of April 25.
  • The office approved waivers covering all plans in 1,347 applications, or about 95 percent of applications.
  • For another 25 applications, CCIIO approved waivers for some and denied others in the same application.
  • The office denied waivers covering all plans in 40 applications, and three applications were pending at the time of the GAO's review.
  • About 3 million people were covered in the approved plans while about 153,000 people were covered in plans that were denied.

"According to the CCIIO officials, applications with a projected premium increase of 10 percent or more tended to be approved while applications with a projected premium increase of 6 percent or less tended to be denied," the report said.  "Applications with a premium increase between 7 percent and 9 percent warranted additional reviews to determine if the application met the agency's data."

Source: Jessica Zigmond, "GAO Notes Apparent Threshold on Waivers," Modern Health Care, June 14, 2011. "Private Health Insurance: Waivers of Restrictions on Annual Limits on Health Benefits," Government Accountability Office, June 14, 2011.


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