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SIMPLIFIED Health insurers cannot set limits to how much money you can claim for your health over your life-time, or to how much you can claim annually, within reason (see Internal Revenue Code for the bar health insurers can set for annual limits -- they cannot be ‘unreasonable’).

However, health insurers can place annual and lifetime limits on the benefits your beneficiaries (children, for example) can receive, as long as those limits are allowed under Federal and State law.

ORIGINAL

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(a) In General- A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish--

(1) lifetime limits on the dollar value of ben-efits for any participant or beneficiary; or

(2) unreasonable annual limits (within the meaning of section 223 of the Internal Revenue Code of 1986) on the dollar value of benefits for any partici-pant or beneficiary.

(b) Per Beneficiary Limits- Subsection (a) shall not be construed to prevent a group health plan or health insurance coverage that is not required to pro-vide essential health benefits under section 1302(b) of the Patient Protection and Affordable Care Act from placing annual or lifetime per beneficiary limits on specific covered benefits to the extent that such limits are otherwise permitted under Federal or State law.

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H.R.3590PATIENT PROTECTION AND AFFORDABLE CARE ACTSponsored by Sen. Richard Durbin (IL)

Health insurers cannot set limits to how much money you can claim for your health overyour lifetime, or to how much you can claim annually, within reason (see Internal RevenueCode for the bar health insurers can set for annual limits -- they cannot be ‘unreasonable’).

However, health insurers can place annual and lifetime limits on the benefits yourbeneficiaries (children, for example) can receive, as long as those limits are allowed under...#health care #insurance

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54 summaries 32 threadshealth care,ISSUES insurance, annual lifetime limits, beneficiaries

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(a) In General- A group health plan and a healthinsurance issuer offering group or individualhealth insurance coverage may not establish--

(1) lifetime limits on the dollar value of benefitsfor any participant or beneficiary; or

(2) unreasonable annual limits (within themeaning of section 223 of the Internal RevenueCode of 1986) on the dollar value of benefits forany participant or beneficiary...

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Health plan, insurance, lifetimelimits, annual limits, etc.

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