Recent headlines from certain news outlets are leading some to think that the out-of-pocket maximum and minimum value plan certification parts of the Affordable Care Act (ACA, or health care reform law) have been delayed until 2015. This is not true. The delay is for combining a shared out-of-pocket maximum for plans that have “multiple service providers” (like a separate pharmacy benefits manager). Medical plans, new and renewing January 1, 2014, and later do need to have out-of-pocket maximums that are not more than $6,350 for single coverage and $12,700 for coverage of spouse or family. Our plans and systems are being updated so that cost shares do not go over the out-of-pocket maximum.
To help sort out the facts from fiction, read this fact sheet that tells what the link is among the employer mandate, the parts that were delayed, the minimum value plan certification requirement and the out-of-pocket maximum cost sharing rule.
Article Courtesy: Anthem BCBS
