Out-of-pocket limits delayed in health law (Business Record)

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Out-of-pocket limits delayed in health law (Business Record)

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By Joe Gardyasz

In another setback for President Obama's health care initiative, the administration has delayed until 2015 a provision in the law that limits how much people may have to spend on their own health care, The New York Times reported.


The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But under a little-noticed ruling, federal officials have granted a one-year grace period to some insurance plans that have separate policies or different benefits managers for different parts of their coverage.


Under the policy, many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, a consumer may be required to pay $6,350 for doctors' services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager.


In Iowa, some health plan members of Wellmark Blue Cross and Blue Shield will keep the same out-of-pocket limits through the end of 2014, a company representative confirmed.


In June, Wellmark announced an offer to extend current health plan provisions for its under-65 individual members and small business groups through the end of 2014, with no increase in base rates.


"For a group who elects to extend their plan year, they will keep their current out-of- pocket for the bulk of 2014 or until they roll onto an (Affordable Care Act)-compliant plan," said Traci McBee, a Wellmark spokeswoman.


Current out-of-pocket maximums offered under Wellmark plans vary, with some being lower than the delayed limit and others being higher, McBee said. A group may elect to have a different limit, but it will need to be at or under the new maximum amount, she said.


Last month, the White House announced a one-year delay in enforcement of another major provision of the law, which requires larger employers to offer health coverage to full-time employees.


Small business groups have sought a similar one-year delay in implementation of the individual mandate of the health care law, citing a continuing lack of information about how it will be implemented.


The discovery of the new delay on out-of-pocket limits is "further evidence of a process that has been mired with incomplete and lacking information on the impact this law will have on America's self-employed and micro-business community," said Katie Vlietstra, director of government affairs for the National Association for the Self-Employed, which represents the nation's 23 million self-employed businesses.

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