No more lifetime health benefit insurance caps in Maine

By Ramona du Houx

May 23rd, 2010 

Rep. Seth Berry talks about his health care bill
Rep. Seth Berry talks about his health care bill
Imagine a loved one in dire need of medical care but unable to get it because an insurance loophole stops their coverage. It happens all too often in America; in Maine a new law will change that reality.

An Act To Protect Health Care Consumers from Catastrophic Debt, sponsored by Rep. Seth Berry, protects health insurance consumers from annual and lifetime health-benefit caps.

“There are many people who suffer through bankruptcy because of a life-threatening illness, even though they thought their insurance policy would cover their costs,” said Rep. Seth Berry. “Insurance needs to be insurance. If you have a major medical policy, and you’ve paid your premiums all along, you should not be cut off when you are in the most need. This law protects people from going into bankruptcy to pay their medical bills. When the insurance is most needed, it will be there for you.”

Theresa D’Andrea and her husband Rocky advocated for the bill. Rocky passed away from cancer just days before the bill’s passage in the Maine Legislature. D’Andrea now faces $60,000 in unpaid medical bills because her husband’s care in his last months was not covered by insurance, due to a cap on the policy.

“This is an important piece of consumer protection legislation,” said Governor Baldacci. “As the very moving story of Rocky and Theresa D’Andrea shows, it’s often too late that someone understands or even knows what annual or lifetime caps are under their health insurance plan.”

When President Barack Obama visited Maine, he cited the D’Andreas as an example of why the elimination of insurance caps is needed.

“The president recognized Theresa and said that no family should ever have to go through what she and Rocky did, and he’s right,” said Baldacci. “Maine’s law will go into effect before the provision against caps in the federal law, and so once again Maine stands proud to be a leader in health care.”

The federal comprehensive health reform package eliminates the caps, but those provisions do not take effect until 2014. Maine’s new law takes effect in July.

“I’m sure Rocky would be so glad and proud knowing Maine understood our plight and has passed this bill, so others need not suffer,” said D’Andrea.

Maine has realigned its community health outreach programs, making them more accessible, which will help when implementing the federal health-care reform. The most recent addition to Maine’s Dirigo Health Reform is the Governor’s Universal Wellness Program, which is promoting preventative care and healthy lifestyles.

“The laws that Maine has on the books and those we continue to put forward are going to situate Maine well as President Obama’s heath-care law is implemented,” said the governor. “We will continue with the right health-care initiatives for Maine, and they will have a ripple effect in Washington.”

The law applies to health plans issued or renewed on or after Jan. 1, 2011.