Final Heath Care Reform Law Regulation Limits Employee’s Out-of-Pocket Expenses

By Max Mihelich

Feb. 21, 2013

A final health care reform law regulation limits employee out-of-pocket expenses for group health care plans. The final regulation was issued Feb. 20 by the U.S. Department of Health and Human Services.

According to the law, an employee’s maximum annual out-of-pocket expenses cannot exceed the maximum limit allowed for that year for contributions to health savings accounts. The regulation will go into effect starting in 2014.

Out-of-pocket expenses include deductibles, coinsurance and copayments for services received through in-network providers, according to the regulation.

The 2013 maximum contribution limit to an HSA for an employee with single coverage is $6,250 and $12,500 for family coverage. The Internal Revenue Service is expected to release the contribution limits for 2014 in May.

The new contribution limits will affect non-grandfathered health care plans. Ultimately, grandfathered health care plans will also be expected to comply with the regulation as they will no longer meet health care reform law requirements over time because such plans are able to raise the maximum contribution limit, according to the HHS.

Max Mihelich is Workforce’s editorial intern. Follow Mihelich on Twitter at @workforcemax. Comment below or email

Max Mihelich is a writer in the Chicago area.


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