- 8,448
Subj: EMBEDDED OOP Limits for 2016
YAgents touched on this subject in another thread 2 weeks ago... Contained within a broader 2/27/2015 rule, HHS is requiring that all 2016 plans use "embedded" OOP $$ limits. Here's a plain language description:
"This embedded rule means that plans (including self-funded plans) will now have to have embedded out-of-pocket limits for each individual covered under family coverage.
For example, using the 2016 limits, if a family plan has an annual out-of-pocket limit of $10,000 and one family member incurs an expense of $20,000, that family member would be responsible for expenses up to $6,850 (the self-only out-of-pocket limit), and the remaining $13,150 would be paid in full by the plan. Additional expenses incurred by that family member would be paid by the plan with no cost sharing for the remainder of the plan year.
Although it is not stated expressly in the preamble, the other family members (or a single family member) should be responsible for the remaining $3,150 of expenses under the family cap of $10,000. Of course, after the family group reaches the $10,000 out-of-pocket limit, the group has no further cost sharing for the rest of the plan year."
Source: Bryan Cave Benefits and Executive Compensation Blog
Overview of the Multifaceted 2/27/15 Rule: PPACA World 2016: Dates, risks, flops | LifeHealthPro
Question: Is this handling of Out-of-Pocket in 2016 different than how most insurance plans currently treat the OOP distribution within families?
ac
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March 27, 2015
"Small Group" Plans Re-defined by A.C.A. - Eff: January 1, 2016
"A little-noticed provision in the Affordable Care Act could have a big impact on companies with 100 workers or less in 2016. The law changes the definition of small group health plans to include all companies of that size, bringing them under more requirements for benefits that must be covered as well as rules limiting premium differences based on age and gender. Currently, companies with 51 to 100 employees can buy plans in the large group market, which has less stringent regulations.
That means that many companies in the 51-100 size group with younger, healthier employees are likely to face higher premiums, while companies in that size group with older, sicker employees will pay less, according to an issue brief released March 3 by the American Academy of Actuaries."
Source: Little-Noticed ACA Provision Could Impact Small Group Plans in 2016 | Bloomberg BNA
YAgents touched on this subject in another thread 2 weeks ago... Contained within a broader 2/27/2015 rule, HHS is requiring that all 2016 plans use "embedded" OOP $$ limits. Here's a plain language description:
"This embedded rule means that plans (including self-funded plans) will now have to have embedded out-of-pocket limits for each individual covered under family coverage.
For example, using the 2016 limits, if a family plan has an annual out-of-pocket limit of $10,000 and one family member incurs an expense of $20,000, that family member would be responsible for expenses up to $6,850 (the self-only out-of-pocket limit), and the remaining $13,150 would be paid in full by the plan. Additional expenses incurred by that family member would be paid by the plan with no cost sharing for the remainder of the plan year.
Although it is not stated expressly in the preamble, the other family members (or a single family member) should be responsible for the remaining $3,150 of expenses under the family cap of $10,000. Of course, after the family group reaches the $10,000 out-of-pocket limit, the group has no further cost sharing for the rest of the plan year."
Source: Bryan Cave Benefits and Executive Compensation Blog
Overview of the Multifaceted 2/27/15 Rule: PPACA World 2016: Dates, risks, flops | LifeHealthPro
Question: Is this handling of Out-of-Pocket in 2016 different than how most insurance plans currently treat the OOP distribution within families?
ac
----------
March 27, 2015
"Small Group" Plans Re-defined by A.C.A. - Eff: January 1, 2016
"A little-noticed provision in the Affordable Care Act could have a big impact on companies with 100 workers or less in 2016. The law changes the definition of small group health plans to include all companies of that size, bringing them under more requirements for benefits that must be covered as well as rules limiting premium differences based on age and gender. Currently, companies with 51 to 100 employees can buy plans in the large group market, which has less stringent regulations.
That means that many companies in the 51-100 size group with younger, healthier employees are likely to face higher premiums, while companies in that size group with older, sicker employees will pay less, according to an issue brief released March 3 by the American Academy of Actuaries."
Source: Little-Noticed ACA Provision Could Impact Small Group Plans in 2016 | Bloomberg BNA
