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Unlimited Benefits

Unlimited Benefits

Prior to the Affordable Care Act, most insurance policies were subject to “maximum annual limits” and “lifetime maximum benefits”. These amounts would vary from policy to policy and carrier to carrier, but most would have a maximum amount that they would pay out in the event of a catastrophic illness or injury. Though the majority of people would not even come close to these limits, some people did find that the limitations were not as generous as thought once they reached them. As medical costs continue to rise, policy limitations were a great concern for many. Therefore, the practice of policy maximums was addressed by the Affordable Care Act and limitations were removed.

While certain policies, usually HMO plans, already offered unlimited lifetime benefits, many others set caps on how much the policy would ultimately pay out. This could vary from a few hundred thousand to several million depending on the plan. However, these limitations have been eliminated for Annual and Lifetime Limits for Essential Health Benefits, a comprehensive set of services. As of September 23, 2013, Annual limits were removed, while January 1, 2014 is the when Lifetime maximums are a thing of the past.

Essential Health Benefits Include:

  • Ambulatory Patient Services
  • Hospitalization
  • Maternity and Newborn Care
  • Rehabilitative and Habilitative Services
  • Mental and Behavioral Health Treatment
  • Prescription Drugs
  • Preventive Care and Wellness Services
  • Pediatric Services
  • Chronic Disease Management
  • Laboratory Services

California’s Essential Health Benefits

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Exceptions to Lifetime and Yearly Limits Requirement:

  • Insurers can still impose limitations and maximum benefits on services not falling under the essential health benefit definition
  • Some carriers have filed for waivers to extend the time to remove the maximum annual limit

Health Exchange Quote is here to answer any questions you have. Call us today for a free quote and assistance with all of your health insurance needs.

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