https://fdms.erulemaking.net/.../component/submitterInfoCoverPage?Call=Print&PrintId=0900006480b36483&Comment=true[8/23/2010 9:48:17 AM]

PUBLIC SUBMISSION

As of: August 23, 2010

Received: August 20, 2010

Status: Pending_Post

Tracking No. 80b36483

Comments Due: August 27, 2010

Submission Type: Web

Docket: HHS-OS-2010-0014

Patient Protection and Affordable Care Act: Preexisting Condition Exclusions, Lifetime and Annual Limits,

Rescissions, and PatientProtections

Comment On: HHS-OS-2010-0014-0001

Patient Protection and Affordable Care Act: Preexisting Condition Exclusions, Lifetime and Annual Limits,

Rescissions, and PatientProtections

Document: HHS-OS-2010-0014-DRAFT-0023

Comment on FR Doc # 2010-15278

Submitter Information

Name: Burns Mary

Organization: NYS Insurance Department

General Comment

The comments in the attached file are being submitted on behalf of the NYS Insurance Department.

Attachments

HHS-OS-2010-0014-DRAFT-0023.1: Comment on FR Doc # 2010-15278
Comments for HHS on its Interim Final Rules Relating to Preexisting Condition Exclusions, 

Lifetime and Annual Limits, Rescissions and Patient Protections

File Code OCIIO-9994-IFC

1. In addition to group and individual insurance, a number of states (including New 

York), have another category of health insurance known as blanket insurance. It is very 

similar to group insurance, however, it constitutes its own separate category. It is unclear 

from the Interim Final Rules as to whether the rules are applicable to blanket insurance. 

We favor uniformity in the health insurance market and suggest that the rules pertaining 

to group insurance be extended to also apply to blanket insurance.

2. It is not clear from the Interim Final Rules whether the provisions regarding lifetime

and annual dollar limits apply to policies that are not available to the general public (e.g., 

individual conversion policy). The New York Insurance Law provides for conversion to 

individual policies for individuals losing coverage under certain types of group policies.

These conversion policies contain lifetime and annual limits as provided for by state 

statute. However, they are only available to those individuals whose coverage ceases 

under the group policies described in the statute. The policies are not otherwise available 

to the general public for purchase. We suggest the rules clarify whether the prohibition 

of lifetime and annual limits applies to policies such as these that are not available to the 

general public.

3. The Interim Final Rules regarding lifetime and annual dollar limits make no 

distinction between in-network and out-of-network benefits. New York has interpreted 

this to mean that the rules apply to both types of benefits. However, we have received 

inquiries from insurers asking whether limits on out-of-network benefits would still be 

permissible. We suggest the rules clarify whether the prohibition of lifetime and annual 

dollar limits applies to both in-network and out-of-network benefits. 

4. The Interim Final Rules regarding coverage for emergency services set forth the 

amount an enrollee may be required to pay for out-of-network provider charges relating 

to emergency services. New York does not view the Interim Final Rules as limiting state 

hold harmless protections. Clarification should be provided indicating that states may 

continue to apply hold harmless protections and that health plans may be required to pay 

amounts in excess of the amounts identified in Sections 147.138 (b)(3)(i)(A), (b)(3)(i)(B) 

and (b)(3)(i)(C).

5. It is unclear from the Interim Final Rules as to whether the rules are applicable to 

categories of groups in addition to employer groups such as associations. We favor 

uniformity in the group market and suggest that the rules be extended to all categories of 

recognized groups.

6. The Interim Final Rules regarding lifetime and annual dollar limits are silent as to 

whether plans may continue to utilize other types of lifetime or annual limitations, such 

as lifetime or annual visit limits. It is our understanding that a question was raised at the 

recent NAIC meeting as to whether the annual and lifetime limits apply to the number of 

visits as well as to dollar amounts. We suggest the rules clarify whether the number of 

visits is in any way limited by the regulation.