Fairness of insurance caps is questioned

"I needed a rest," said Brockington, now 44. "This was the first time I felt like I was getting older, that I needed to slow down, that I needed to get out of retail because these kids were driving me crazy."

Her problem wasn't kids or retail.

On May 19, "I was on the floor, doing my work, and I couldn't move," she recalled. "I was like having an out-of-body experience."

An employee walked past, and "I couldn't even talk to him. I wanted to tell him, 'Would you please help me?' "

She dragged herself home to Lawnside and into bed.

The next morning, her friend and manager, Cheryl Monaco, "told me to go to the hospital because in the 15 years she's known me, I've never been sick. She said go or she was going to call my mother."

Brockington went to Cooper University Hospital - for 48 days.

Acute myeloid leukemia.

Brockington had been paying $19 a week from her paycheck for health insurance.

For 16 months, insurance covered chemotherapy, a bone marrow transplant, five months in hospitals.

But on Aug. 28, 2008, a letter came from her plan administrator. Brockington had reached her "lifetime maximum coverage of $2 million."

In five days, she would be uninsured.

"I started freaking out," Brockington recalled. "We started working on my options, what I could do, and there wasn't a whole lot."

More than half of all employer-based insurance plans in America have lifetime caps limiting how much can be spent on any one employee, according to a Kaiser Family Foundation survey.

Because of rising health-care costs, more Americans appear to be reaching those caps, even though cases are still rare. Insurance companies and employers say by capping lifetime expenses for any one employee, they can afford better benefits to all employees.

"The primary reason for . . . caps is to lower the cost of insurance so employers can cover as many people as possible," said Mary McElrath-Jones, spokeswoman for UnitedHealthcare, parent company of UMR, administrator of Brockington's health plan.

Many find caps to be unfair.

"What insurance is supposed to do best is handle the extraordinary thing that is rare," said Gary Claxton, health policy expert at the Kaiser Family Foundation. "So to some extent, these policies are not protecting the people who most need insurance. These people did everything they were supposed to do. They were paying their premiums. Insurance companies are finding ways to limit exposure of these policies to really sick people."