QUESTION

My employer plan still has an annual limit. Is that still allowed?

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ANSWER

Plans that comply with the Affordable Care Act cannot have annual or lifetime limits on benefits that are considered essential health benefits. However, plans can apply annual limits to services that are not part of the essential health benefits, even if they are covered services. Plans are also allowed to impose non-dollar limits on benefits, such as visit limits. Check the details of your plan to see how the annual limit is applied in your coverage. Your Summary of Benefits and Coverage will provide that information. See also the Alternative Coverage section to learn more about plans that do not meet the Affordable Care Act’s requirements. (45 C.F.R. § 147.126; 45 C.F.R. § 147.200).

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