HHS Waivers Allow “Mini Med” Health Plans To Continue

The Department of Health and Human Services (HHS) has established a process under which group health plans or insurers may apply for waivers from the new restrictions on health plan annual limits (and lifetime limits) established under recently enacted health reform legislation. For plan or policy years beginning on or after September 23, 2010, interim regulations require no dollar limits on certain “essential benefits” and health plan annual coverage limits of no less than $750,000 with the amount rising to $2 million two years thereafter.

The waivers in part are intended to allow “limited benefit” plans or “mini med” plans, which typically have annual limits far below levels that the new rules allow, to continue to be offered until 2014 when new insurance market rules and other major coverage expansion reforms come into place. These plans tend to have lower premiums. In sub-regulatory guidance, HHS’ Office of Consumer Information and Insurance Oversight states: “These group health plans and health insurance coverage often offer lower-cost coverage to part-time workers, seasonal workers, and volunteers who otherwise may not be able to afford coverage at all.” Long term care providers are among the types of employers that offer these mini med plans to employees. Waiver applications must include “a brief description of why compliance with the interim final regulations would result in a significant decrease in access to benefits for those currently covered by such plans or policies, or significant increase in premiums paid by those covered by such plans or policies, along with supporting documentation.”

More information about the waiver process, the regulations, and a list of approved waivers can be found at: http://www.hhs.gov/ociio/regulations/patient/index.html. A sample of a waiver application prepared by the law firm Greenberg Traurig, LLP, is available at: http://www.ahcancal.org/ncal/advocacy/Documents/OutlineSampleWaiverApplication.pdf.