ACA rule limits out-of-pocket-expenses for employees in health plans


A final health care reform law regulation seeks to limit how much out-of-pocket expenses group health care plans can ask employees to cover, likely affecting most large employers’ plans.

The new rule is part of the federal Affordable Care Act (ACA).

The U.S. Department of Health and Human Services issued the mandate, which states maximum out-of-pocket expenses cannot exceed the out-of-pocket limit set for that year. It applies to high-deductible health care plans linked to health savings accounts (HSAs).

The maximum limit to a HSA for single-coverage employees is $6,250 and $12,500 for families. The Internal Revenue Service expects to announce 2014’s limits in May.

The new limits apply to non-grandfathered plans. Grandfathered plans will phase out, eventually not meeting requirements like to what degree employers may increase employee premium contributions.

The final rule only affects most large employer plans because few employers include copayments in setting employees’ out-of-pocket contribution limits, according to experts.

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