The Affordable Care Act (ACA) requires non grand fathered health plans to limit an enrollee’s out-of-pocket costs for essential health benefits each year. This annual limit is often referred to as the “out-of-pocket (OOP) maximum.”
Recent agency guidance will require the self only OOP maximum to be embedded family coverage when the plan’s OOP maximum for family coverage exceeds the ACA’s limits for individual coverage. This requirement will take effect beginning with the 2016 plan year, when the OOP maximum for self-only coverage will be $6,850. This guidance applies to all non grandfathered group health plans, including self-funded plans and insured plans of all sizes. Read More
