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Annual dollar maximums on certain benefits to be eliminated effective Dec. 1, 2010
Posted by:
AFTRA H&R
Tuesday, November 09, 2010
Under the new health reform law, health plans may no longer impose annual benefit maximums for overall health benefits. The law also restricts plans’ ability to apply annual dollar maximums to specific types of benefits that are deemed “essential.” While the AFTRA Health Plan does not have an annual overall benefit maximum, the Plan does currently include annual dollar maximums for three specific benefits deemed essential under the new law. Effective Dec. 1, 2010, the annual dollar maximums for these specific benefits will be eliminated as outlined below:
- The AFTRA Health Plan’s wellness benefit for preventive services currently includes a $400 annual maximum per individual and $1,200 annual maximum per family, as described on pages 50-51 of the 2005 AFTRA Health Fund SPD, in the August 2008 Benefits Update and in the December 2008 Benefits Update. Effective Dec. 1, 2010, these annual dollar maximums will be eliminated.
- The AFTRA Health Plan’s chemical dependency benefit currently includes a lifetime limit of three courses of treatment with different dollar limit maximums for each course of treatment, as outlined on pages 45-46 of the 2005 AFTRA Health Plan SPD. Effective Dec. 1, 2010, the dollar limit maximums for chemical dependency treatment described on these pages will be eliminated, but the lifetime limit of three courses of treatment will remain the same.
- The AFTRA Health Plan’s dental benefit covers certain preventive services, with an annual maximum of $1,000 per individual in any calendar year, subject to certain specific limitations set forth on pages 52-55 of the 2005 Health Plan SPD. Effective Dec. 1, 2010, the $1,000 annual maximum will be eliminated with respect to pediatric (children under age 19) dental services only. The annual maximum remains in place for all dental services for individuals age 19 and older. All other limitations set forth on page of the 2005 Health Plan SPD related to dental coverage remain in place.
Please note that while these annual dollar limitations are being eliminated as outlined above, all benefits remain subject to the terms, conditions and limitations set forth in the 2005 Health Plan SPD, Benefits Updates and any other notices and modifications issued regarding the Health Plan. If you have any questions concerning these benefits, please contact AFTRA H&R’s Participant Services at (800) 562-4690.
Category: Health reform and Health Plan changes