Out-of-pocket maximums delayed one year in health care law

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