On June 17, 2011, the U.S. Department of Health and Human Services (HHS) issued additional guidance with respect to the annual waiver limit program.  The annual waiver limit program allows issuers or other group health plan sponsors to apply for a waiver from the annual limit requirements if they present evidence that meeting the annual limits would result in diminished access to benefits or a significant increase in premiums.  Typically, issuers or group health plan sponsors that offer extremely basic coverage would be interested in applying for the annual limit waiver program.

Importantly, recipients of these waivers must take action between June 24, 2011 and September 22, 2011 in order to preserve those waivers through the end of 2013. In addition, new applicants must submit applications under the annual limit waiver program between June 24, 2011 and September 22, 2011 in order to receive a new waiver.  Extensions or new applications not received on or before September 22, 2011 will not be eligible for an annual limit waiver and will need to comply with the requirements of the Patient Protection and Affordable Care Act (PPACA).

Additional Modifications to the Annual Limit Waiver Program

The following additional modifications were made to the annual limit program:

  • Health plans and issuers will no longer need to apply for a waiver each year. 
  • Plans and issuers that have secured waivers must distribute a notice each year to all eligible participants informing them of the waiver.
  • As a condition of the extension, updates must be filed by December 31, 2012 and December 31, 2013 providing the same materials as are required for the extension.

Click here for the new HHS Guidance.