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Health reform law rule limits employees' out-of-pocket expenses


Most group health care plans will be limited in how much out-of-pocket expenses they can require employees to pick up, according to a final health care reform law regulation.

The regulation, issued Wednesday by the U.S. Department of Health and Human Services, says the maximum annual out-of-pocket expenses — which include deductibles, coinsurance and copayments for services received through in-network providers — cannot exceed the maximum out-of-pocket limit allowed that year, starting in 2014, for high-deductible health care plans linked to health savings accounts.

In 2013, the maximum limit to an HSA for an employee with single coverage is $6,250 and $12,500 for family coverage. The 2014 limits are expected to be announced in May by the Internal Revenue Service.

These new cost-sharing limits will apply to non-grandfathered health care plans. Eventually, most grandfathered plans are expected to lose that status because they will no longer meet health care law requirements, such as limits imposed on how much employers can increase employee premium contributions.

The final rule will have a direct impact on most large employer plans. That is because only a small percentage of employers include copayments in setting limits on how much employees can be required to pick up in out-of-pocket expenses, said Rich Stover, a principal with Buck Consultants L.L.C. in Secaucus, N.J.