Regulatory Resources
The U.S. Department of Health and Human Services recently announced that a group health plans’ annual in-network out-of-pocket maximum for Essential Health Benefits (EHBs) for the 2017 plan year cannot exceed $7,150 for self-only coverage and $14,300 for family coverage. The in-network individual out-of-pocket maximum applies to all individuals, regardless of whether the individual is covered by a self-only plan or family plan (including a high-deductible plan).
Self-funded group health plans are not required to cover EHBs. But, if they do, they cannot impose lifetime or annual dollar limits on those benefits.
For more information on cost sharing, follow this link.