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Clause may let ‘mini-meds’ off the hook

By Carol Gentry
6/23/2010 © Health News Florida

The low annual payout limits on skimpy health plans, including the state's own "Cover Florida" program, are supposed to go away in September under new federal rules released Tuesday afternoon. But a close reading of the rules shows some wiggle room.

The new rules bar lifetime limits and severely restrict annual limits on coverage – the kinds of caps that are frequently found in small-group and individual plans, and sometimes even in large-group plans.

While most provisions under the new federal health law go into effect in 2014, some are triggered on Sept. 23, six months after the signing of the Patient Protection and Affordable Care Act. The barring of lifetime limits and constraints on annual limits are part of the “Patient’s Bill of Rights” that President Obama released Tuesday.

Insurers that offer limited-benefit plans, often called “mini-meds,” have warned that lifting the caps would require a hike in premiums. Employers of low-wage and part-time workers who rely on mini-meds say the skimpy plans are better than nothing, which is what those workers would be stuck with until 2014 if premiums go up significantly.

Meanwhile, the staff of Gov. Charlie Crist is concerned that the new rule could affect more than 6,000 Floridians enrolled in Cover Florida who have health problems and thus cannot find affordable coverage in the free market. Some of the plans in the governor's signature program for the uninsured have very limited coverage, with caps as low as $50,000.

The Crist team and others may find hope in one clause in the 196-page rule book. It says that the Department of Health and Human Services can grant an exemption for limited-benefit plans if the denial of the exemption would cause those enrolled to lose coverage. HHS will have to devise an appeals program to hear such cases.

Here, in typical government-speak, is the clause that pertains:

"So that individuals with certain coverage, including coverage under a limited benefit plan or so-called “mini-med” plans, would not be denied access to needed services or experience more than a minimal impact on premiums, these interim final regulations provide for the Secretary of Health and Human Services to establish a program under which the requirements relating to restricted annual limits may be waived if compliance with these interim final regulations would result in a significant decrease in access to benefits or a significant increase in premiums. Guidance from the Secretary of Health and Human Services regarding the scope and process for applying for a waiver is expected to be issued in the near future."

So stay tuned.

--Carol Gentry, Editor, can be reached at 727-410-3266 or by e-mail.