Finance 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.
Under this reg, each member of a non-grandfathered family plan would only be subject to the individual cost-sharing limit for his or her expenses instead of the higher family limit ($14,300 v. $7,150 for 2017).
Here’s how the embedding rule would apply to a family plan with a $10,000 limit in 2017: If a spouse on the plan racked up $15,000 in medical expenses, that individual could only be required to pay $7,150 in spite of the plan’s $10,000 limit.