New Obamacare guidance clarifies new employee-friendly rule

by Jared Bilski

The last time HHS tried to clarify this tricky Obamacare reg, it confused many employers even further.

So the DOL, Treasury and HHS again tackled out-of-pocket costs under the Affordable Care Act in a recent FAQ.

The ‘embedded’ rule

In the previous guidance, HHS clarified that the when the rules take effect in 2016, the limits will be set at: $6,850 for single coverage and $13,700 for family plans.

But the HHS added a new “embedded” requirement that capped the out-of-pocket limits for each individual covered under a family plan at the single coverage maximum.

In other words, each member in the family plan would only be subject to the individual cost-sharing limit for his or her expenses instead of the higher family limit of $13,700.

Here’s how the embedding rule would apply to a family plan with a $10,000 limit: If a spouse on the plan racked up $15,000 in medical expenses, that individual could only be required to pay $6,850, in spite of the plan’s $10,000 limit.

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