Here are five points:
1. The regulatory guidance was jointly issued by the U.S. Departments of Health and Humans Services and Labor and Treasury in May. The rule will be effective starting 2016.
2. The guidance states the maximum out-of-pocket expense employers can force employees to pay before health plan coverage will be $6,850 for single coverage and $13,700 for family coverage.
3. Additionally, employers will have to cap at $6,850 for the maximum out-of-pocket expense any individual with family coverage can be mandated to pay before family coverage. The $6,850 cap will apply regardless if the individuals has family or single coverage.
4. Various business groups appealed to federal regulators claiming an “embedded” cost limit would not be supported the healthcare reform law. However, regulators stated they are maintaining the new requirement.
5. In the wake of the regulators’ decision to maintain healthcare spending limits, businesses may have to raise premiums to offset the mandated plan design change.
More articles on coding & billing:
Making headway with payers: Texas ASC Society & BCBSTX meet on site of service, costs, bundled payments & more
8 things to know about ASC reimbursement
Coding deadline causing physicians’ anxiety — 6 points
