Blogs - Practical Benefits Lawyer

How Required Individual Out-of-Pocket Maximum under Family Coverage Works with a High Deductible Health Plan

March 17, 2015
We previously posted a summary of the ?Ç£clarification?Ç¥ under the Affordable Care Act to the effect that an individual out-of-pocket maximum (?Ç£OPM?Ç¥) may need to be embedded in family coverage. ?áA new FAQ describes how this embedded individual OPM works with a high deductible health plan (?Ç£HDHP?Ç¥). A HDHP that has, for example, a $10,000 family deductible may provide payment for covered medical expenses for a covered person (without violating statutory requirements applicable to HDHPs) if that covered person has incurred covered medical expenses during the year of at least $2,600 (the minimum deductible for a 2015 family HDHP). The HDHP must also apply the individual OPM limit ($6,600 in 2015) to each covered person in the HDHP, even if this amount is below the plan?ÇÖs $10,000 family deductible limit. ?áThe FAQ can be found here.
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