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Did You Know... 2019 ACA Limits

07/13/18

  09:38:00 pm, by MedBen5   , 188 words,  
Categories: Health Care Reform

Did You Know... 2019 ACA Limits

Capitol-Caduceus-Money Collage

The following limitations and penalties apply as of the first day of your plan’s 2019 plan year per the Affordable Care Act (ACA):

Standard Plan Out-of-Pocket Maximums

  • $7,900 for self-only (employee-only) coverage
  • $15,800 for other than self-only coverage

(Over these thresholds, employers must pay 100% of the benefits covered by the plan.)

High Deductible Plan Out-of-Pocket Maximums

  • $6,750 for self-only (employee-only) coverage
  • $13,500 for other than self-only coverage

(Other than preventive, all services must be paid by employee until above thresholds are met, then employers must pay 100% of the benefits covered by the plan.)

Employer-Shared Responsibility Penalties

  • $2,500 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
  • $3,750 per each employee for whom the employer-offered coverage is deemed unaffordable

Affordability Safe Harbors

Employee cost-share for employer-offered coverage must be less than 9.86% 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.

  • $12,140 – Federal Poverty Level (FPL) Safe Harbor Amount for 2019

MedBen clients who have questions regarding 2019 ACA limits may contact Vice President of Compliance Caroline Fraker at (800) 851-0907 or cfraker@medben.com.

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