Annual Limit

A cap on the benefits an insurance company will pay in a year for the health insurance plan a person is enrolled in. These limits are sometimes placed on certain services such as prescriptions or hospitalizations. After an annual limit is reached, the enrollee must pay all associated health care costs for the rest of the year. Annual limits on essential health benefits are permissible at specified levels through the end of plan years that begin in 2013 (e.g. fiscal plan from 7/1/2013 through 6/30/2014). HHS has an established waiver program for plans that expire in 2014.