PPACA Out-Of-Pocket Expense Limit Finally Defined By Govt.

The regulation, issued Wednesday by the U.S. Department of Health and Human Services, says the maximum annual out-of-pocket expenses — which include deductibles, coinsurance and copayments for services received through in-network providers — cannot exceed the maximum limit allowed that year, starting in 2014, for contributions to health savings accounts

Health reform law rule limits employees’ out-of-pocket expenses

Jerry Geisel

February 20, 2013 – 3:03 pm ET

Most group health care plans will be limited in how much out-of-pocket expenses they can require employees to pick up, according to a final health care reform law regulation.The regulation, issued Wednesday by the U.S. Department of Health and Human Services, says the maximum annual out-of-pocket expenses — which include deductibles, coinsurance and copayments for services received through in-network providers — cannot exceed the maximum limit allowed that year, starting in 2014, for contributions to health savings accounts.In 2013, the maximum limit to an HSA for an employee with single coverage is $6,250 and $12,500 for family coverage. The Internal Revenue Service is expected to announce the 2014 HSA contribution limits in May.These new cost-sharing limits will apply to non-grandfathered health care plans. Eventually, most grandfathered plans are expected to lose that status because they will no longer meet health care law requirements, such as limits imposed on how much employers can increase employee premium contributions.The final rule will have a direct impact on most large employer plans.  That is because only a small percentage of employers include copayments in setting limits on how much employees can be required to pick up in out-of-pocket expenses, said Rich Stover, a principal with Buck Consultants L.L.C. in Secaucus, N.J.Other employers also could be impacted by the new requirement because their health care plans’ current out-of-pocket limits exceed the HSA contribution limits, Mr. Stover said.

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