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.