The application process will be used
by HHS to grant some insurance issuers a waiver of the limitation
on the annual limits requirement.
Section 2711(a)(2) of
the Public Health Service Act (PHS Act) requires the Secretary to
impose restrictions on the imposition of annual limits on the
dollar value of essential health benefits for any participant or
beneficiary in a new or existing group health plan or a new policy
in the individual market for plan or policy years beginning on or
after September 23, 2010 and prior to January 1, 2014. The
restricted annual limits on the dollar value of essential benefits
cannot be lower than: o For plan or policy years beginning on or
after September 23, 2010 but before September 23, 2011, $750,000; o
For plan or policy years beginning on or after September 23, 2011
but before September 23, 2012, $1.25 million; and o For plan or
policy years beginning on or after September 23, 2012 but before
January 1, 2014, $2 million. A class of plans, generally known as
"limited benefit" plans or "mini med" plans, often has annual
limits well below those set out in the regulation. These plans
offer affordable coverage to part-time workers and volunteers. In
anticipation of any perceived or potential disruption to coverage
resulting from the application of these new standards to plans, the
interim final regulation contemplated a waiver process prior to
January 1, 2014 for cases in which "compliance with these interim
final regulations would result in a significant decrease in access
to benefits or significant increase in premiums." Plans can seek a
waiver by submitting an application that includes: 1. The policy
form(s) for which a waiver is sought. 2. The number of individuals
covered by the form(s) submitted; 3. The annual limits and rates
applicable to the forms submitted; 4. A short description of why
compliance with these interim final regulations would result in a
significant decrease in access to benefits or significant increase
in premiums. 5. An attestation, signed by the Chief Executive
Office of the issuer of the coverage, certifying that the
application of restricted annual limits to such policies would
result in a significant decrease in access to benefits for those
currently covered by such policies, or a significant increase in
premiums paid by those covered by such policies. The Chief
Executive Officer would retain documents in support of this
application for potential examination by the Secretary. The Office
of Consumer Information and Insurance Oversight (OCIIO) is
requesting emergency action for this clearance by the Office of
Management and Budget. We are requesting emergency processing
procedures for this application because this waiver process is
needed immediately to reduce the possibility of a reduction in
employer-offered insurance options for employees. As indicated
above, the minimum annual limit requirements go into effect for
plan or policy years beginning on or after September 23, 2010.
Employers typically make insurance offering decisions for the
following calendar year in August and September; therefore, if we
want to limit coverage disruptions, we need to provide detail on
the waiver process immediately. Plans and employers are already
signaling that unless we provide details on the waiver process in
the immediate future, they intend to drop coverage. Due to the
urgency and short time frames associated with the data collection,
OCIIO does not have sufficient time to allow for the usual comment
timeframe required in the PRA process. We are requesting an
Emergency Review for this collection and OMB approval of the
package by August 19, 2010.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.
Waiver Process