Insurer Prevails On Appeal Of Contract, ACA Out-Of-Pocket Cap Rulings

Mealey's (April 26, 2022, 2:06 PM EDT) -- NEW YORK — The shortness of an insurance communication and the fact that it repeatedly referred to other plan documents placed an insured on notice that the contract included other terms and nothing in the Patient Protection and Affordable Care Act (ACA) required the insurer to apply the individual out-of-pocket cap to prescription drug purchases rather than the family cap, a panel of the Second Circuit U.S. Court of Appeals said in affirming a trio of district court rulings on April 22....