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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements
View requirements for Local Plan and BlueCard Out-of-Area members.

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No Annual Dollar Limits - Some Waivers Granted by HHS

The Patient Protection and Affordable Care Act (PPACA or health care reform law) restricts annual limits on the dollar value of essential health benefits. The interim final rules for this provision indicated that plans can apply for a waiver if compliance with the provision would significantly decrease access to benefits or significantly increase premiums. Some of our employer groups have applied for and received this waiver from the U.S. Department of Health and Human Services (HHS), which means that some member policies could still carry annual dollar limits on essential health benefits after their policy renewal date.  
These waivers are valid for one year from the employer group’s renewal date, and members will be notified if their employer group has been granted a waiver. As previously communicated, provider should continue to verify eligibility and benefits for all members. Verifying member benefits will ensure that you have the most accurate information about how new health care reform laws impact each member. 
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