Individual Health Insurance: No More Lifetime Limits?

The other day I wrote about Terry,  a woman with a health insurance policy from Pacificare that is being “converted” to a UnitedHealthcare policy because United took over Pacificare about five years ago.   The new policy is a terrible policy and I have been trying to get answers from somebody/anybody who can tell me how this can be allowed – particularly because the woman involved has no choice but to accept whatever United gives her, since she is un-insurable due to diabetes and other health conditions.

The worst part of this woman’s “conversion policy” is a lifetime limit to her  health insurance benefits:  $250,000.  That amount of money could be used up during one stay in a hospital! And I thought the Affordable Care Act put an end to this kind of limit.  I did some research about the law and found that such limits will no longer be allowed in 2014, but allowable lifetime benefit limits are supposed to be $750,000 after September 23, 2010 through September 2011; $1,250,000 in 2012; $2 million in 2013.  So it looks like insurance companies can still limit the amount of money they will pay out.  And then there is the question of whether or not Terry’s new policy is considered a “grandfathered” plan to which the Affordable Care Act does not apply.

Yesterday I was looking at Blue Cross Blue Shield of Arizona’s individual health insurance plans – and I noticed something was missing from the benefits information page for each individual policy.  There was no mention of a lifetime benefits limit.

I called up Blue Cross Blue Shield of Arizona to be sure I wasn’t misreading the information. And what did I learn?  Blue Cross Blue Shield of Arizona is no longer putting lifetime benefit limits on their health insurance policies. They are implementing elements of the Affordable Care Act now and not waiting until 2014.  Blue Cross Blue Shield of Arizona policies also cover preventive care at 100%  (and the deductible does not apply to these services).  This is another part of the Affordable Care Act which Blue Cross Blue Shield of Arizona has already implemented.

On the UnitedOne website for individual insurance policies, the plans have either a $3 million or $5 million lifetime benefit limit.  So where did United come up with the conversion policy for Terry?  Did they just make up a policy for her?

I’m still trying to get answers about Terry’s insurance.  Terry is afraid to talk to United, for fear that they might take away the lousy policy.  I told Terry they can’t do that – but then again, I wouldn’t think they could convert her to such a lousy policy.

What Next?

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