ACA: Out of Pocket Max clarification

If you are reading up on ACA and all the changes that are happening as the government tries to roll out this complicated legislation, you may have heard that out of pocket maximums are no longer in effect.  Well… not exactly.  A few articles did clarify it correctly, but a number of articles did not state specifically what was affected and why.  So, here is what one of the insurance carriers said when clarifying the issue.

“You may have read media stories the past few days reporting that the Affordable Care Act (ACA) out-of-pocket maximum (OOPM) requirements have been delayed. We want to clear up any confusion.

The stories are actually referring to the OOPM safe harbor for group health plans and group health insurance issuers for the 2014 plan year, which the federal government announced back in February. Although the issue is now getting media coverage, nothing has changed since February. The safe harbor applies to non-grandfathered group health plans when benefits under the plan are administered by more than one service provider.”

So, in short, only group plans are affected and only group plans where benefits are administered with separate service providers (i.e. mental health, precription and medical could be separate).  This will effect very few people and, to me, is pretty much a non-story.

As I have stated, there are many good things in the ACA and plenty of bad things.  There is no need to inflate the seriousness of this issue.  Focus on the more serious issues that need to be fixed.

More to come…  Do you have Blue Cross Blue Shield (BCBS) individual policy or a group policy?  Stay tuned as BCBS has recently stated their transition plans and also suggests what other health insurance issuers will be doing before October 1.  This is big news and will be in my next blog entry.


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