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Health Care Reform: HHS Issues Final Regulations on Essential Health Benefits


February 2013

The Department of Health and Human Services issued final regulations on the Affordable Care Act’s standards for essential health benefits, actuarial value, and accreditation. While these regulations primarily affect insurance carriers in the individual and small group markets, one portion of the regulations is particularly relevant for all employers who provide group health plans. HHS revealed that 2014 annual limitations on out-of-pocket limits (under Section 1302(c)(1) of the Affordable Care Act) will apply to all group health plans, including self-insured plans and large group market plans, whereas the deductible limits (under Section 1302(c)(2) of the Affordable Care Act) will only apply to insured plans in the small group market. For illustrative purposes, the out-of-pocket limits for 2013 are $6,250 for self-only coverage, and $12,500 for non-self only coverage (such as family coverage). Amounts for 2014 are expected to be released by the IRS in the spring of 2013. While further rulemaking is expected on this issue, employers should be prepared to adjust their 2014 maximum out-of-pocket limits accordingly. 

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