Feds release new health plan out-of-pocket limits: Key ACA implication

by Jared Bilski

HR pros are a group that always likes to be one step ahead of the curve. And the feds just released some key benefits figures that will help you do just that.  

The Departments of Health and Human Services (HHS) have released next year’s out-of-pocket maximums for employee health plans.

The out-of-pocket limits for non-grandfathered plans beginning on or after January 1, 2017 are $7,150 for single coverage (up from $6,850 in 2016), and $14,300 for family coverage (up from $13,700).

The out-of-pocket maximums include plans’ annual deductibles as well as any in-network cost-sharing obligations plan participants have after the deductible is met.

What isn’t required to be included with the out-of-pocket maximums: premiums, pre-authorization penalties, and any out-of-pocket expenses that are associated with out-of-network benefits.

Obamacare’s ’embedded’ rule

Another thing firms need to be mindful of with these limits is the “embedded” out-of-pocket maximum rule.

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