Much has been
written in the last few days about a delay in the out-of-pocket maximums for
individuals and families that are part of the health care law, beginning
January 1, 2014. The statutory limit for
all non-grandfathered health plans is governed by the limits of plans tied to
Health Savings Accounts (HSA). These HSA
limits are published annually by the Federal Government and the limits for 2014
will be $6,350 for individual in-network expenses and $12,700 for family
in-network expenses.
The delay that
the national press has been writing about this week actually emanates from a
Department of Labor (DOL) announcement on February 20, 2013. In that announcement, the DOL gave transition
relief to health plans that have separate vendors for medical coverage and
prescription drug coverage. The
transition relief is intended to provide Pharmacy Benefit Managers (PBM),
Insurers, and Employer Health plans time to integrate the data transfers
required to implement a single out-of-pocket maximum for individuals and
families across different technology platforms.
Those plans affected by the transition relief must comply beginning
January 1, 2015.
For those plans
health plans with a single vendor, such as AultCare’s Insured Plans and most of
our self-insured plans, the out-of-pocket maximum will be integrated in 2014
for both the health plan and the pharmacy benefit to the limits of $6,350 for
Individuals and $12,700 for Families.
Mike Novelli, Vice President Reform Implementation at AultCare
