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SOME GOOD NEWS ABOUT EMPLOYER LIFETIME LIMITS
Insurance lifetime limits can affect individuals
with bleeding disorders that use factor products on a regular basis.
Individuals most affected are those with severe hemophilia, who have high
factor product costs.
Not all insurance has a lifetime limit.
Medicare and Medicaid have no lifetime limit. Employer group insurance
(insurance that people have through their work) is the most common type of
insurance and often has a lifetime limit. Individual insurance also
often has a lifetime limit, but only a very few individuals with bleeding
disorders have insurance through an individual plan. The few Wisconsinites that
have such a plan most commonly have it through the state high risk plan (HIRSP).
Now to some good news about employer insurance
lifetime limits from the Kaiser Family Foundation and Health Research and
Educational Trust/Employer Health Benefits 2004 Annual Survey. The
following is summary information on all employer plans- both small (3- 199
employees) and large (200 or more employees):
·
49% of plans have no
lifetime limit.
·
25% of plans have a lifetime limit
of 2 million dollars or more.
·
Only 1% of plans have a lifetime
limit of one million or less.
·
24% of employer plans have a
lifetime limit of between one and two million dollars.
The Report documents that the average lifetime
limit is well above the one million dollar figure, which is many times used as a
figure nationally.
One other bit of good news about lifetime
limits. There has been an increase in the number of drug plans that cover
factor products and such plans typically do not have a lifetime limit.
Lifetime limits remain an issue for the bleeding
disorders community and particularly for those individuals with a lower lifetime
limit. Hopefully the trends of increased limits and coverage of factor
products under drug plans will continue and make lifetime limits less of an
issue for our community.
For any questions or comments, please call
GLHF’s
Financial Projects Coordinator, David Linney at (414) 257-0200 or toll-free at
(888) 797-4543.
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