Insurers cannot put lifetime dollar limits on essential health benefits for plan years effective on or after September 23, 2010. Essential health benefits include items and services in these categories:
- Ambulatory patient services
- Emergency services
- Laboratory services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Pediatric services, including oral and vision care
- Prescription drugs
- Preventive and wellness services and chronic disease management
- Rehabilitative and habilitative services and devices
Health plans may put other non-dollar limits on essential health benefits. An example of a non-dollar limit is the number of visits allowed.
Group health plans may put lifetime dollar limits on specific covered benefits that are not "essential health benefits,” unless otherwise prohibited under federal or state law.
For more information on lifetime limitsor on health care reform, visit healthcare.gov or uhc.com/reform.
This communication is not intended as legal or tax advice. Please contact a competent legal or tax professional for personal advice on eligibility, tax treatment and restrictions. Federal and state laws and regulations are subject to change.