2021 proposed out-of-pocket maximum for group health plans announced

Out-of-pocket maximums (OOPMs) for group health plans are adjusted annually by the U.S. Department of Health and Human Services (HHS) and were released in the annual draft Notice of Benefit and Payment Parameters on Jan. 30. The proposed 2021 figures, outlined below, represent about a 4.9% increase over the 2020 parameters.

Proposed  maximum OOPM for 2021 plan year Current  maximum OOPM for 2020 plan year
Self-only: $8,550 Self-only: $8,150
Family: $17,100 Family: $16,300

The annual OOPM requirement applies to most non-grandfathered group health plans, regardless of fully insured or self-funded (ASO) status. It does not apply to transitional relief and retiree-only plans. The OOPM includes copayments, deductibles and coinsurance amounts associated with both medical and pharmacy covered benefits.

High-deductible plans with health savings accounts (HSAs) have varied OOPM, deductible and contribution limits. UnitedHealthcare is still awaiting Internal Revenue Service (IRS) final rules for 2021 HSA limits — historically released in May — and will communicate the information once available.

For questions, contact your UnitedHealthcare representative.

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