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By the Numbers: Your 2018 Health Plan Budget


  11:26:00 pm, by MedBen5   , 209 words,  
Categories: Compliance

By the Numbers: Your 2018 Health Plan Budget


Working on your 2018 health plan budget? If so, you’ll want to keep the following limitations and penalties in mind. The following apply as of the first day of your plan’s 2018 plan year:

Out-of-Pocket Maximums

  • $7,350 for self-only (employee-only) coverage.
  • $14,700 for other than self-only coverage.
  • Over these thresholds, employers must pay 100% of the benefits covered by the plan.

Employer-Shared Responsibility Penalties

  • $2,320 per employee (for all employees combined) if qualifying coverage is not offered to 95% of the employer’s employees working 30 or more hours per week.
  • $3,480 per each employee for whom the employer-offered coverage is deemed unaffordable.

Affordability Safe Harbors

  • 9.56% – Employee cost-share for employer-offered coverage must be less than 9.56% of one of the ACA safe harbor amounts (federal poverty level, W-2 salary or hourly rate of pay) for cost-share to be deemed affordable. Note: this is a reduction from the 2017 percentage.
  • $12,060 – Federal Poverty Level (FPL) Safe Harbor Amount for 2018.

PCORI Fee (Due July 31, 2018)

  • $2.39 per covered life for plan years ending on October 31, 2017, November 30, 2017 or December 31, 2017.
  • $2.26 per covered life for all other plan years.
  • A “covered life” means each and every individual covered under an applicable plan (i.e., employee, retiree, spouse, and dependent).

MedBen clients who have questions regarding these numbers are welcome to contact Vice President of Compliance Caroline Fraker at 800-851-0907 or

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