Human Resources
Final Rule Limits Out-Of-Pocket Maximums; Addresses Minimum Value and Essential Health Benefits

Final Rule Limits Out-Of-Pocket Maximums; Addresses Minimum Value and Essential Health Benefits


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Employers received an unwelcome answer from the Department of Health and Human Services (HHS) when the agency issued a final rule providing that out-of-pocket (OOP) limits up to the health savings account (HSA) OOP limit will apply to all non-grandfathered group health plans in the self-insured and large group markets. The final rule also sets forth the methods for employer-sponsored self-insured group health plans to determine whether their plans provide minimum value (MV). However, the new rule provides little clarification on the determination of essential health benefits (EHBs) for purposes of complying with the prohibition on annual and lifetime dollar limits on EHBs. The final rule, implemented by the Patient Protection and Affordable Care Act (Affordable Care Act), was published in the Federal Register on February 25, 2013 and becomes effective on April 26, 2013.

The Aon Hewitt bulletin below discusses the following parts of the final rule released by HHS:

  • Application of the OOP limit to self-insured and large group health plans;
  • Calculation of MV for self-insured and fully insured plans in the large group market; and
  • Determining EHBs for purposes of the prohibition on annual and lifetime dollar limits.

Download Final Rule Limits Out-Of-Pocket Maximums: Addresses Minimum Value and Essential Health Benefits