Starmark® self-funded plan designs’ in-network out-of-pocket limits have been updated to incorporate the 2016 ACA cost-sharing and high-deductible health plan changes. The in-network out-of-pocket limits for 2016 plan years are:
- PPO plans (Not HSA Qualified)
- Individual: $6,850
- Family: $13,700
- Individual: $6,550
- Family: $13,100
- The ACA individual out-of-pocket limit of $6,850 will apply to individuals covered under family coverage with an HDHP (this is a new requirement in 2016).
- For plans with a calendar-year benefit period, services received during the calendar year prior to the start of the new 2016 plan year may exceed the $6,850 cost-sharing limit.