The application process will be used by HHS to grant some insurance issuers a waiver of the limitation on the annual limits requirement.
Section 2711(a)(2) of the Public Health Service Act (PHS Act) requires the Secretary to impose restrictions on the imposition of annual limits on the dollar value of essential health benefits for any participant or beneficiary in a new or existing group health plan or a new policy in the individual market for plan or policy years beginning on or after September 23, 2010 and prior to January 1, 2014. The restricted annual limits on the dollar value of essential benefits cannot be lower than:
o For plan or policy years beginning on or after September 23, 2010 but before September 23, 2011, $750,000;
o For plan or policy years beginning on or after September 23, 2011 but before September 23, 2012, $1.25 million; and
o For plan or policy years beginning on or after September 23, 2012 but before January 1, 2014, $2 million.
A class of plans, generally known as "limited benefit" plans or "mini med" plans, often has annual limits well below those set out in the regulation. These plans offer affordable coverage to part-time workers and volunteers. In anticipation of any perceived or potential disruption to coverage resulting from the application of these new standards to plans, the interim final regulation contemplated a waiver process prior to January 1, 2014 for cases in which "compliance with these interim final regulations would result in a significant decrease in access to benefits or significant increase in premiums."
Plans can seek a waiver by submitting an application that includes:
1. The policy form(s) for which a waiver is sought.
2. The number of individuals covered by the form(s) submitted;
3. The annual limits and rates applicable to the forms submitted;
4. A short description of why compliance with these interim final regulations would result in a significant decrease in access to benefits or significant increase in premiums.
5. An attestation, signed by the Chief Executive Office of the issuer of the coverage, certifying that the application of restricted annual limits to such policies would result in a significant decrease in access to benefits for those currently covered by such policies, or a significant increase in premiums paid by those covered by such policies.
The Chief Executive Officer would retain documents in support of this application for potential examination by the Secretary.
The Office of Consumer Information and Insurance Oversight (OCIIO) is requesting emergency action for this clearance by the Office of Management and Budget. We are requesting emergency processing procedures for this application because this waiver process is needed immediately to reduce the possibility of a reduction in employer-offered insurance options for employees. As indicated above, the minimum annual limit requirements go into effect for plan or policy years beginning on or after September 23, 2010. Employers typically make insurance offering decisions for the following calendar year in August and September; therefore, if we want to limit coverage disruptions, we need to provide detail on the waiver process immediately. Plans and employers are already signaling that unless we provide details on the waiver process in the immediate future, they intend to drop coverage.
Due to the urgency and short time frames associated with the data collection, OCIIO does not have sufficient time to allow for the usual comment timeframe required in the PRA process. We are requesting an Emergency Review for this collection and OMB approval of the package by August 19, 2010.
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Waiver Process