GAO Reports on Waiver Limit Requests

To implement various provisions of the Patient Protection and Affordable Care Act (PPACA), including those related to restricted annual limits on the value of “essential” covered health benefits, the HHS established the Center for Consumer Information and Insurance Oversight (CCIIO), now a part of the Centers for Medicare & Medicaid Services (CMS). Under the program, issuers or other group health plan sponsors may apply for a waiver from the annual limits, as defined by the Secretary of Health and Human Services (HHS), if they attest and present evidence that meeting the annual limits would result in diminished access to benefits or a significant increase in premiums (see McDonalds Reported Seeking HCR Waiver). 

The GAO survey specifically investigated the number of applications the CCIIO received for an annual limit waiver, how many of these were approved or denied, and the reasons provided by the CCIIO for approvals and denials of annual limit waivers. 

The studies major findings included: 

• As of April 25, 2011, the CCIIO received a total of 1,415 applications.  
• For 1,347 of the applications (over 95%) the CCIIO approved waivers covering all plans in the applications. 
• For 25 applications, the CCIIO approved waivers for some plans and denied waivers for others within the same application. 
• The CCIIO denied waivers covering all plans in 40 applications. 
• Approximately 3 million people were covered in approved plans.  
• Approximately 153,000 people were covered in denied plans.  
•  Three applications were pending at the time of review. 

The CCIIO granted waivers on the basis of an application’s projected significant increase in premiums or significant reduction in access to health-care benefits. Applications with a projected premium increase of 10% or more tended to be approved while applications with a projected premium increase of 6% or less tended to be denied.  

The full report is available  here.