HHS Sets Waiver Process for Mini-Med Plans

On September 3, HHS released guidance on a process for min-med and other health plans for waivers from health care reform’s restricted annual dollar limits on essential benefits. The following is an explanation of the waiver process.

A class of group health plans and health insurance coverage, generally known as “limited benefit” plans or “mini med” plans, often has annual limits well below the restricted annual limits set out in the interim final regulations. These group 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. In order to ensure that individuals with certain coverage, including coverage under limited benefit or mini-med plans, would not be denied access to needed services or experience more than a minimal impact on premiums, the interim final regulations contemplated a waiver process for plan or policy years beginning prior to January 1, 2014 for cases in which compliance with the restricted annual limit provisions of the interim final regulations “would result in a significant decrease in access to benefits” or “would significantly increase premiums.” This waiver process does not impact any State law requirements addressing annual benefit limits in group health plans or group and individual health insurance coverage.

The Waiver Process

A group health plan or health insurance issuer may apply for a waiver from the restricted annual limits set forth in the interim final regulations if such plan or the coverage offered by such issuer was offered prior to September 23, 2010 for the plan or policy year beginning between September 23, 2010 and September 23, 2011 by submitting an application not less than 30 days before the beginning of such plan or policy year, or in the case of a plan or policy year that begins before November 2, 2010 not less than 10 days before the beginning of such plan or policy year. The application must include:

  1. The terms of the plan or policy form(s) for which a waiver is sought;
  2. The number of individuals covered by the plan or policy form(s) submitted;
  3. The annual limit(s) and rates applicable to the plan or policy form(s) submitted;
  4. 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 any supporting documentation; and
  5. An attestation, signed by the plan administrator or Chief Executive Officer of the issuer of the coverage, certifying 1) that the plan was in force prior to September 23, 2010; and 2) that the application of restricted annual limits to such plans or policies would result in a significant decrease in access to benefits for those currently covered by such plans or policies, or a significant increase in premiums paid by those covered by such plans or policies.

The plan administrator or Chief Executive Officer should retain documents in support of this application for potential examination by the Secretary.

HHS will process complete waiver applications within 30 days of receipt, except that complete applications submitted for plan or policy years beginning before November 2, 2010 will be processed no later than 5 days in advance of such plan or policy year.

A waiver approval granted under the process set forth in this memorandum applies only for the plan or policy year beginning between September 23, 2010 and September 23, 2011. A group health plan or health insurance issuer must reapply for any subsequent plan or policy year prior to January 1, 2014 when this waiver expires in accordance with future guidance from HHS. HHS may modify this waiver approval process after reviewing the information provided in connection with the waiver process set forth in the guidance and other relevant releases.

A group health plan or health insurance issuer that provides coverage that would meet the above criteria and that wishes to obtain a waiver of the restricted annual limit requirements should apply for such waiver by submitting the items referenced above within the timeframe described above to HHS, Office of Consumer Information and Insurance Oversight, Office of Oversight, attention James Mayhew, Room 737-F-04, 200 Independence Ave. SW, Washington, DC 20201 or emailing the items to  HHS Sets Waiver Process for Mini Med Plans (use “waiver” as the subject of the email).

Where to get more information:

If you have any questions, please contact the the Office of Consumer Information and Insurance Oversight at (301) 492 4100 or email at  HHS Sets Waiver Process for Mini Med Plans (use “waiver” as the subject of the email).