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What are restricted annual limits and lifetime maximums under the PPACA?

Questco - PEO - HR Oursourcing - Staffing - BenefitsWhat are restricted annual limits and lifetime maximums under the PPACA?

Health care reform ends the lifetime limit on the cost of essential health benefits, known as the lifetime maximum limit. The law requires plan’s starting on or after September 23, 2010 to follow the rule. The lifetime maximum rule does not apply to grandfathered individual plans.
The law also ends annual cost limits on the value of essential health benefits, known as annual dollar limits.Health care reform raises the annual dollar limit each year for all employer and new individual plans:

Plan’s beginning September 23, 2010 have a limit of $750,000

Plan’s starting September 23, 2011 have a limit of $1.25 million


Plans effective on September 23, 2012 have a limit of $2 million

On January 1, 2014 the limits end for most plans.

The PPACA does allow some limits. There can be a limit on the cost per visit per hour and on the number of visits over a period of days. For example, a person can be limited to three annual visits, but with no cost limits per visit.

Some people may no longer be on their employer’s group health plans because they are at the plan’s lifetime maximum limit. This may also be true of dependents. The PPACA allows these people to rejoin plans during the open enrollment period on or after Sept. 23, 2010.

Health care reform allows these limits for non-essential health benefits.

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