Zane Benefits Publishes New Information on the Delay in ObamaCare Consumer Protection.

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Some insurers will have an extra year to comply with consumer out-of-pocket annual limits.

Today, Zane Benefits, the number one online small business health benefits solution, published new information on the delay in ObamaCare consumer protection.

According to Zane Benefits’ website, there has been a delay in a key consumer protection provision of the Affordable Care Act ("ObamaCare") for some insurers and employers.

Originally to be implemented in 2014, this ObamaCare provision specified that there must be an overall limit on consumer's annual out-of-pocket costs for deductibles, co-payments, and co-insurance. The new out-of-pocket annual limits are $6,350/year for individuals and $12,700/year for families.out of pocket health reform

Seems simple, but complexity results from separate policies from one employer, multiple benefits administrators per plan, (i.e. medical care and pharmacy), and other health plan aspects that may have multiple parts. This creates complexity in implementation, because current technology does not support benefits administrators to merge the out-of-pocket maximums across plans and management platforms.

Because of this administrative complexity, the administration has delayed the out-of-pocket annual limits for some insurers and employers with more than one benefits administrator. These insurers and employers do not have to combine their members’ out-of-pocket spending into one total until 2015.

The one-year postponement of the consumer out-of-pocket limits applies only to group health plans and only to plans which use multiple independent administrators to handle health insurance benefits. Individual policies still must comply with the out-of-pocket limits.

Here is the exact language presented in the DOL FAQ:

The Departments have determined that, only for the first plan year beginning on or after January 1, 2014, where a group health plan or group health insurance issuer utilizes more than one service provider to administer benefits that are subject to the annual limitation on out-of-pocket maximums under section 2707(a) or 2707(b), the Departments will consider the annual limitation on out-of-pocket maximums to be satisfied if both of the following conditions are satisfied:

The plan complies with the requirements with respect to its major medical coverage (excluding, for example, prescription drug coverage and pediatric dental coverage); and

To the extent the plan or any health insurance coverage includes an out-of-pocket maximum on coverage that does not consist solely of major medical coverage (for example, if a separate out-of-pocket maximum applies with respect to prescription drug coverage), such out-of-pocket maximum does not exceed the dollar amounts set forth in section 1302(c)(1).

Source: US Department of Labor FAQ.

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About Zane Benefits
Zane Benefits was founded in 2006 to provide a revolutionized SaaS (Software-as-a-Service) administration platform ("ZaneHRA") for Health Reimbursement Arrangements (HRAs) and defined contribution health care. The flagship software provides a 100% paperless administration experience to small businesses and insurance professionals that want to offer better health benefits without a traditional group health insurance plan at lower costs. For more information about ZaneHRA, visit

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Christina Merhar
Zane Benefits
800-391-9209 6725
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