Annual Limit

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Annual Limit


Annual Limit means a Yearly Limit

• A cap on the benefits your insurance company will pay in a year while you're enrolled in a particular health insurance plan.

These caps are sometimes placed on particular services such as prescriptions or hospitalizations.

Annual limits used to be placed on the dollar amount of covered services or on the number of visits that would be covered for a particular service.

• One common limit was to allow only six office visits a year, with all others being applied to the deductible.

After an annual limit's dollar value was reached, people had to pay all health care costs for the rest of the year.

♦ Starting in 2014, the Affordable Care Act bans annual dollar limits.

For plans issued or renewed beginning January 1, 2014, all annual dollar limits on coverage of essential health benefits was prohibited.

♦ Grandfathered individual health insurance policies are not required to follow the rules on annual limits.

Limits are still possible

A plan may include day or visit limits as long as they don't associate a dollar amount with them.

If plan has a benefit that is not defined as an Essential Health Benefit (EHB), it can assign an annual limit.

Insurance companies can still find way to limit some things like prescriptions as long as it is not based upon dollar amounts.

Related content

Grandfathered Plans

Essential Health Benefits