starting immediately, changes would be made in their medical coverage. Although the million dollar lifetime limit would remain, the lifetime limit for one particular diagnosis was changing. There was now a lifetime maximum of $5,000 for benefits payable for claims related to this one particular diagnosis. Care to guess what this one particular diagnosis was? That’s right, it was the serious medical condition that Chops happened to have. No other limitations were placed on any other catastrophic illnesses. Now Chops was worried. With a Back in the late 1980’s there million dollar limit, he didn’t need to worry about paying for his health care was a fellow in Texas who out of his own pocket. But he exhausted the new $5,000 limit on coverage for worked for a music company. his illness in only 5 months. Which meant that the I’m going to call him Chops, insurance company wouldn’t pay another penny which is not his real name. ever again for any more treatment related to this Anyway, Chops had a pretty diagnosis. good job. In addition to his Seem fair to you? It didn’t to Chops. So salary, he also got some nice benLee he sued. The case went all the way up to the efits, including health insurance. But his health insurance had a Aronson United States Supreme Court. The result: “an employer has an absolute right to alter cap: the absolutely positively most the insurance would pay for medical the terms of medical coverage available to plan beneficiaries.” Chops was out of luck. care over Chop’s lifetime was one million And that was the law of the land for the dollars. That’s not something Chops was next 20 some odd years. But due to a new worried about. After all, a million dollars law that just went into effect, not any is a lot of money. He wasn’t even worried when he got di- more. Before this new law, many agnosed with a serious medical condition. health plans set a dollar limit on what they would spend for your He went to his employer and told them covered benefits during the entire everything about his diagnosis in March time you were enrolled in that 1988. Chops followed his doctor’s orders plan: otherwise known as a lifetime and was able to continue to work. But in limit or lifetime cap. But under this new July 1988, the Music Company informed law, The Affordable Care Act, lifetime limits or its employees, including Chops, that
LAWS of the land
Insurance Blues
18
December 2010
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