2021 proposed out-of-pocket maximum for group health plans announced
- Fully Insured and Self-Funded
- All States
- Reform and Regulatory
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.
Highdeductible 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.