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Annual dollar limits being phased out

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annual dollar limits

As of January 1, 2014, annual dollar limits set by health care plans are gone. This is the dollar limit on their yearly spending for your covered benefits.

Here's what's different

In the past, health plans could put a limit on how much your plan would pay in any one year. This annual dollar limit has been phased out, so your coverage won't run out if you have a bad year.*

How it impacts you

If you have a serious health problem in a given year, you don't have to worry about whether your plan will pay for the mounting cost for care.

I'm going to be having a baby. Can my health plan apply an annual dollar limit on maternity care?

No. The law protects limits on maternity care because it is an "essential benefit". Other essential benefits under the law include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

Can my health plan apply an annual dollar limit on dental benefits?

Yes. Under the law, adult dental care is a "non-essential benefit".

Is there a reform law that applies to lifetime dollar limits?

Yes. Learn more about lifetime dollar limits.

* Have health insurance under a grandfathered plan? If so, you might not get these benefits. If there is any difference between the information on this website and your health plan, your policy's provisions will apply.

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