ACA and Out of Pocket Maximum Limits

January 9, 2015

Out-of-Pocket Maximum Limits


The 2015 annual out-of-pocket maximums (OOP) for non-grandfathered group health plans are $6,600 for self-only coverage and $13,200 for any coverage other than self-only coverage. The transition rule allowing an exemption for stand-alone prescription drug plans applied only to the first plan year beginning on or after January 1, 2014 and is not available for plan years starting on or after January 1, 2015.  Trustees will want to ensure that the plan has been amended to reflect any needed changes to comply with these rules.  Plans must also coordinate the accumulation of the maximum out of pocket amounts between the third-party administrator, the medical claims vendor and the prescription drug vendor.




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