April 4, 2014 Compliance Observer – Annual Deductible Limit Repealed for Small Health Plans

Compliance Observer - April 4, 2014Annual Deductible Limit Repealed for Small Health Plans

Source: Zywave/EBIA Checkpoint

Congress has passed, and the President has signed, the Protecting Access to Medicare Act of 2014 (Act) into law.   While Medicare is its primary focus, the legislation contains other provisions not directly related to Medicare, including elimination of health care reform’s limitations on annual deductibles that applied to health plans in the small group market.  However, the Act does NOT eliminate the ACA’s out-of-pocket maximum, which applies to all non-grandfathered health plans for plan years beginning on or after Jan. 1, 2014.

As background, starting in 2014, health care reform established maximum annual deductibles of $2,000 for a plan covering a single individual and $4,000 for any other plan (indexed for increases in health insurance costs). In the preamble to final regulations issued in February 2013, HHS had clarified that these limits would apply only to the small group insurance market—not to self-insured employer plans or to the large group insurance market.  Elimination of the deductible limits is retroactively effective to when the ACA was enacted in March 2010, essentially treating the limits as though they had never been part of the law.

Small employer health plans that have started their 2014 plan years (for example, calendar year plans) were already required to incorporate the ACA’s annual deductible limit, unless a higher limit applied due to the actuarial value exception. It is not likely that these plans will be affected by the repeal of the ACA’s deductible limit until their 2015 plan years.  However, those that have not started their 2014 plan years (for example, health plans with a Nov. 1 to Oct. 31 plan year) may be able to avoid the ACA’s deductible limit altogether.

The legislation also makes a change to HIPAA’s electronic transaction standards; delaying adoption of ICD-10 medical data code sets (updated codes used to classify diseases and health problems) until at least October 1, 2015.  This delay will give covered entities and their business associates more time to fully transition to the ICD-10 codes for their HIPAA standard transactions.

 Please contact your AssuredPartners NL benefit team if you have questions or need assistance with these or other compliance matters.

Share This: