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This entry was published on 2014-09-22
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SECTION 3217-F
Prohibition on lifetime and annual limits
Insurance (ISC) CHAPTER 28, ARTICLE 32
§ 3217-f. Prohibition on lifetime and annual limits. (a) An insurer
shall not establish a lifetime limit on the dollar amount of essential
health benefits in an individual, group or blanket policy of hospital,
medical, surgical or prescription drug expense insurance.

(b) An insurer shall not establish an annual limit on the dollar
amount of essential health benefits in an individual, group or blanket
policy of hospital, medical, surgical or prescription drug expense
insurance for policy years beginning on and after January one, two
thousand fourteen.

(c) For policy years beginning prior to January one, two thousand
fourteen, an insurer may establish restricted annual limits on the
dollar amount of essential health benefits in an individual, group, or
blanket policy of hospital, medical, surgical or prescription drug
expense insurance consistent with section 2711 of the Public Health
Service Act, 42 U.S.C. § 300gg-11 or any regulations thereunder.

(d) The requirements of subsections (b) and (c) of this section shall
not be applicable to an individual policy that is a grandfathered health
plan. For purposes of this section, "grandfathered health plan" means
coverage provided by an insurer in which an individual was enrolled on
March twenty-third, two thousand ten for as long as the coverage
maintains grandfathered status in accordance with section 1251(e) of the
Affordable Care Act, 42 U.S.C. § 18011(e).

(e) For purposes of this section, "essential health benefits" shall
have the meaning ascribed by section 1302(b) of the Affordable Care Act,
42 U.S.C. § 18022(b).