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    HHS Issues Out-of-Pocket Maximums

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    HHS Issues Out-of-Pocket Maximums


    The Patient Protection and Affordable Care Act (ACA) limits the amounts that participants in non-grandfathered health plans can be required to pay out-of-pocket for covered services. The Department of Health and Human Services (HHS) recently released new regulatory guidance relevant to employers looking ahead to medical plan renewals for the 2018 plan year. Employers planning for upcoming renewals will want to be aware of the newly announced out-of-pocket maximums applicable to non-grandfathered health plans.

    Who is Affected:

    The out-of-pocket maximum applies to all plans which do not have grandfathered status as defined by the ACA, including full insured, self-funded, large and small group plans. The limits do not apply to retiree-only plans.

    Annual Out-of-Pocket Maximums for 2018:

    Self-Only Coverage: The 2018 out-of-pocket maximum for individuals with self-only coverage will be $7,350 for self-only coverage (an increase of $200 from the $7,150 limit in 2017).

    Family Coverage: The 2018 out-of-pocket maximum for family or other than self-only coverage will be $14,700 (an increase of $400 from the $14,300 limit in 2017).

    Need assistance planning ahead for 2017 and beyond? Contact your American Fidelity representative or email

    American Fidelity Assurance Company does not provide tax or legal advice. While we’re happy to provide you with this general information about the Patient Protection and Affordable Care Act (ACA), given the complexity of these rules, we encourage you to contact your tax or legal counsel about how the new requirements apply to your specific plans or situation.


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