Beginning with the 2014 plan year, all group health plans have mandated out-of-pocket maximums. An out-of-pocket maximum limits the amount that a participant is required to spend on coinsurance, copayments (including prescription drug copayments) and deductibles and does not include amounts spent on premiums. The out-of-pocket maximum limits coordinate with the limits for high-deductible health plans (see “HSA Limits for 2014” below) and are $6,350 for single coverage and $12,700 for all other tiers of coverage in 2014. Plans that use a separate pharmacy benefit manager to pay claims may qualify for limited transition relief in 2014. Please contact a Graydon Head attorney if you would like additional information or would like us to review your plan to determine if any changes are necessary.
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New out-of-pocket maximum rules for all group health plans
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