Lifetime Maximum Changes

[Guest aliciamarie]

Hello-

A group health plan currently has a $1million lifetime maximum. One benficiary of the plan has satisfied their lifetime maximum. The group is looking to move carriers to a plan w/ a $2 million lifetime maximum. They are wondering whether they can exclude this beneficiary from coverage since he already satisified the lifetime maximum under the prior contract. He would be otherwise eligible for the plan. If they don't exclude him can they count the prior $1 million against the new $2 million maximum?

I see problems w/ respect to HIPAA nondiscrimnation by excluding the beneficiary entirely , but wanted to get some additional opinions.

Thank you!

[Guest taylorjeff]

I don't see how they could legally exclude him from coverage, if he is eligible. It would be OK to carry over any "accumulators" from the current plan. For example, the Lifetime Benefit Maximum or any other Lifetime Maximums (mental health visits, TMJ, infertility, or whatever). These would then be deducted from the new benefit maximums.

Hello-

A group health plan currently has a $1million lifetime maximum. One benficiary of the plan has satisfied their lifetime maximum. The group is looking to move carriers to a plan w/ a $2 million lifetime maximum. They are wondering whether they can exclude this beneficiary from coverage since he already satisified the lifetime maximum under the prior contract. He would be otherwise eligible for the plan. If they don't exclude him can they count the prior $1 million against the new $2 million maximum?

I see problems w/ respect to HIPAA nondiscrimnation by excluding the beneficiary entirely , but wanted to get some additional opinions.

Thank you!