Federal regulators believe that new Patient Protection and Affordable Care Act (PPACA) deductible limits apply only to insured small group plans, not to large insured plans or self-insured plans.
The regulators do believe that all group plans, including large insured plans and self-insured plans, must comply with PPACA limits on enrollees’ out-of-pocket spending.
The Employee Benefits Security Administration (EBSA), an arm of the U.S. Labor Department, has presented those interpretations of PPACA in a set of answers to frequently asked questions posted on behalf of the Labor Department, the U.S. Treasury Department, and the U.S. Department of Health and Human Services (HHS) .
The departments posted the answers about PPACA cost-sharing limits to help flesh out some of plan actuarial provisions given in an HHS final rule that is set to appear in the Federal Register Feb. 25.
PPACA includes a provision that caps a group health plan deductible at $2,000 for an individual and $4,000 for a family for plan years starting on or after Jan. 1, 2014, according to analysts at Towers Watson.
PPACA also prohibits group plans from imposing out-of-pocket spending limits that are higher than the maximum limits allowed for the high-deductible plans that are compatible with health savings accounts (HSAs), the Towers Watson analysts report.
For 2013, the out-of-pocket spending limits are $6,250 for a single enrollee and $12,500 for a family.
The Labor Department, the Treasury Department and HHS said they will develop a rule that will state that “only plans and issuers in the small group market will be subject to the deductible limit.”
“Until that rulemaking is promulgated and effective, the departments have determined that a self-insured or large group health plan can rely on the departments’ stated intention to apply the deductible limits imposed by [PPACA] Section 1302(c)(2) only on plans and issuers in the small group market,” officials said.
The departments do believe that all group plans must comply with the PPACA limits on out-of-pocket spending maximums, but they want to make life easier for employers that may use several different vendors to provide health benefits, officials said.