Obama Administration Delays the "out-of-pocket" Maximum Requirement of PPACA
This is something we have been trying to change for some time now and although this requirement has not been completely removed from the law, it has been postponed for at least one year.
After a monumental decision to delay the "Employer Tax Mandate" until 2015, the Obama Administration has announced today that they will delay the "Out-Of-Pocket" (OOP) maximum requirement for at least one year. This provision originally mandated the following for fully insured health plans in 2014:
- A fully insured health plan cannot exceed a deductible of $2000 for an individual and $4000 for a family
- A fully insured health plan cannot exceed a maximum "out-of-pocket" (OOP) of $6350 for an individual and $12,700 for a family
You can review the following press coverage on this recent delay:
What does this mean for "Large Employer Groups" (i.e. 51+ enrolled)?
In addition to the delay of the "Employer Tax Mandate", this essentially means that employers may continue offer plans that exceed OOP maximums of $6350 for an individual and $12,700 for a family - if they can find one. We must keep in mind that the OOP maximum requirement was in existence when the insurance carriers had to submit their plan structures to the Department of Health and Human Services (HHS) for approval back in May of 2013. To our knowledge, carriers will not be able to make plan changes until May of 2014 for a January 2015 effective date so this delay may not have much of an impact at all.
What does this mean for individual health insurance consumers?
Again, unless HHS allows carries to make changes their PPACA compliant plans this late in the game there will be virtually no impact to the individual consumer either. If HHS does allow carriers to update their plans based on this delay we may see additional options on the health insurance exchange that allow you to take a higher risk plan at a lower monthly premium. We will keep you posted on any developments.
We will continue to keep you updated on the changes and delays as they are announced. As always, we welcome your questions and concerns with respect to this legislation and how it may impact you.