To date, the Department of Health and Human Services has provided guidance on certain aspects of how the PPACA applies to the limited medical industry. Specifically, they have addressed Annual Limit Waivers and the interpretation of limited medical minimum loss ratios (MLRs), which has bought another year of survival for most of the limited medical or “mini-med” plans in place which are subject to the Act.  But what will happen in 2011? That’s an answer that will have to play out in time.

What we do know:

Because of their fixed indemnity benefit structure, some limited medical plans, such as the Framework Health Plan, do not meet the definition of a “group health plan” under PPACA. As a result, the Framework Health Plan’s fixed indemnity limited medical product is exempt from the new rules affecting most health plans.  These plans offer a viable option for new business – as well as continuing to serve the thousands of working Americans they already cover. No significant changes at renewal time are expected prior to 2014.

With so much uncertainty surrounding the new rules and the waiver process, the Framework platform remains an experienced and reliable solution for clients with hourly and part-time workers. When evaluating limited medical choices, it’s important to know the experience and history of the companies with whom you partner. Framework has successfully sold and serviced its fixed indemnity line of business for more than 20 years and that experience is evidenced in the satisfaction and long-standing relationships of its clients.

Signs you need stability for your limited medical client:

1. You have a client on a coinsurance based limited medical plan that is subject to PPACA.  Whether or not you received a waiver for any part of your plan for 2011, the product faces many uncertainties, especially with the laser-sharp focus of the government on these plans.  A back-up plan should be in place, if not implemented. 
2. Your group is facing a rate increase.  Rate stability is available in today’s marketplace.  Plans subject to PPACA will not be adding new business and are facing uncertainty in managing costs associated with meeting the Act’s requirements.  If your plan is facing this kind of change, it is time to evaluate other options.
3. HHS has a long way to go.  More regulations could impact plans subject to PPACA.  Why worry about uncertainty when there are better, less controversial options available today?
4. Your client desires to use internal resources on something other than limited medical. A company’s limited medical plan is often a secondary concern for an overtaxed HR department.  Put a plan in a place that isn’t subject to legislative wrangling – which will allow the HR department to focus on other initiatives. 
5. You wish to maintain your current revenue level. Let’s face it, the MLR wording is murky.  If carriers have to cut expenses, guess what is most likely to get chopped first – agent commissions. 

ABOUT THE AUTHOR

Brian Robertson is executive vice president of Fringe Benefit Group, which markets and administers the Framework Health Plan. Fringe Benefit Group has provided and administered limited medical plans for 20 years and today its clients include many of the nation’s leading retail, hospitality and staffing companies. Contact Brian at (800) 551-3424 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .