Friday, September 3, 2010

Enrollment opportunity due to elimination of lifetime dollar limits

Under the Patient Protection and Affordable Care Act (PPACA), health plans can no longer limit overall plan lifetime dollar amounts for plan benefit years beginning on or after September 23, 2010.

According to the interim final rule, plans must provide a notice and enrollment opportunity to otherwise eligible individuals who reached a lifetime limit prior to the effective date of these rules.

The plan must provide the notice and enrollment opportunity by the first day of the first plan year that begins on or after September 23, 2010. Below is model notice language that employers should provide to employees in conjunction with their open enrollment period.

Model Notice
The lifetime limit on the dollar value of benefits under [Insert name of group health plan or health insurance issuer] no longer applies. Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan. Individuals have 30 days from the date of this notice to request enrollment. For more information contact the [insert plan administrator or issuer] at [insert contact information].

For your convenience, we have created a template Enrollment Opportunity Notice to address both the lifetime dollar limit and adult children enrollment opportunities. You can use this notice to communicate these opportunities to employees.

For more information on lifetime and annual dollar limits, please refer to the previous post: Agencies issue guidance on several reform provisions, including annual and lifetime limits.

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