HHS Reaffirms Position on Out-of-Pocket Maximum Limits

The Department of Health and Human Services (HHS) published question-and-answer guidance on May 8, 2015, applying the Affordable Care Act’s limits on out-of-pocket maximum amounts to individuals enrolled in family coverage. HHS’s guidance reiterates HHS’s position that the individual out-of-pocket maximum limit must apply to each individual, regardless of whether that individual is covered under a family tier of coverage.

On May 18, 2015, officials from the Department of Labor (DOL) and Department of Treasury (Treasury) joined HHS and confirmed that these limits apply to large group market and self-insured plans and do not prevent plans from complying with the requirements for health savings account (HSA)-qualified high-deductible health plans (HDHPs). These requirements will go into effect starting with the first plan year beginning on or after January 1, 2016.