AP Blog

By Nathanael Alexander, Esq., 07/08/2020
On June 15, 2020, the Supreme Court of the United States (SCOTUS) held in Bostock v. Clayton County, Georgia that Title VII of the Civil Rights Act of 1964 bars an employer from firing an individual merely for being gay or transgender. In its ruling, the Court noted that it is “impossible to discriminate...
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By Gina Ekstam, 07/08/2020
Agribusiness worksites, shared worker housing, and shared worker vehicles present unique challenges for preventing and controlling the spread of COVID-19. Joint guidance by the CDC and DOL provides a template that employers can adapt to protect their workers. Through thoughtful planning, it is possible to...
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By Nathanael Alexander, Esq., 07/02/2020
Due to the COVID-19 pandemic, countless employees with young children have opted to utilize the time off provisions of the Families First Coronavirus Response Act (FFCRA) in order to provide care to their children in lieu of school and day care center closures nationwide. Now that schools are closed and a vast...
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By Peggy Morrison, 07/01/2020
In light of the COVID-19 pandemic, CMS has established a COVID-19 Focused Survey for Nursing Homes with the expectation that all nursing homes are inspected to ensure appropriate infection control practices are in place to prevent the spread and transmission of COVID-19. According to Quality Certification &...
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By Christine Olmsted, 06/30/2020
The energy industry is one of the top 10 industries targeted for cyberattacks. Increased use of automation systems and the migration of sensitive information to the cloud has helped oil and gas companies become more connected and competitive but these new technologies have also opened the door to cyber criminals...
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By Nancy N. Hill, 06/24/2020
Did you know that you are responsible for the maintenance of utility or service lines that extend from your home to your property line? You may suddenly experience a drop in water pressure, or an unusually high water bill, and then discover that the water pipe under your front lawn has cracked. Your lawn must be...
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By Andy Engardio, 06/23/2020
Great news for motor carriers - the FMCSA’s Crash Preventability Determination Program (CPDP) will be pulling “Not Preventable Crashes” out of your CSA scores! Motor carriers participating in the CPDP will see their Safety Measurement System (SMS) information change within 60 days after the...
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By Cathy Knopf BSN, RN, 06/17/2020
After many months of closure, the nation is beginning to open. With this in mind, the Director of Quality, Safety and Oversight Group for CMS Center for Clinical Standards and Quality issued a memo providing recommendations for state and local officials to utilize while determining the level of mitigation needed...
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By Gina Ekstam, 06/15/2020
As a result of the pandemic, agribusiness operations face additional pressures and are: Rethinking and re-routing product delivery around restrictions Increasing direct or on-farm sales Refocusing resources (e.g., distilleries making hand sanitizer) Adjusting to new rules in order to continue operations...
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Response to the novel coronavirus has increased demand for Personal Protective Equipment (PPE) during a time when supply chain interruptions are occurring across the nation, affecting both acute and senior living healthcare providers. As the number of persons infected with COVID-19 has continued to rise, and as...
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HHS Provides 2021 Benefit Payment Out-of-Pocket Limits
05/20/2020

Earlier this week, the Department of Health and Human Services (HHS) published finalized 2021 Benefit Payment Parameters with an $8,550 out-of-pocket maximum for self-only coverage and $17,100 for family coverage for health plans beginning in 2021. See the 5/14/2020 Federal Register publication here.

Under the Affordable Care Act (ACA), non-grandfathered health plans are required to comply with an overall annual limit on out-of-pocket expenses for essential health benefits. The current limits, for 2020 plan years, is $8,150 for self-only coverage and $16,300 for family coverage.

The IRS has yet to release information on what the 2021 requirements will be for high-deductible health plans (HDHPs) and health savings accounts (HSAs). The HDHP/HSA requirements include a minimum deductible, a maximum out-of-pocket limit and a maximum HSA contribution amount. These requirements apply to both grandfathered and non-grandfathered group health plans.

Here's a summary of both traditional plans and HDHP/HSA plans for the 2020/2021 plan years:

If your plans offer both traditional and HDHP/HSA plans (that are not grandfathered), your plans are subject to both sets of requirements and you must ensure compliance with the lowest applicable out-of-pocket maximum. Plus, the ACA requires that a per person (individualized/imbedded) out-of-pocket maximum doesn't exceed the ACA limit, even if you are in the larger (family) tier.

The rule also finalizes the treatment of drug manufacturer support, including coupons, as it relates to the participant's maximum out-of-pocket exposure. We previously shared guidance (September 4, 2019) about this. Health plans have the ability/the option to determine whether they will count the value of a drug manufacturer's coupons/other assistance when determining if a participant has satisfied his or her cost-sharing obligations - provided that this is consistent with state law. 

Links:

Prior Guidance: