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Self-Funded and Large Group Plans May Need 'Embedded' Cost-Sharing Limits in 2016 (PDF)
BuckLink to more items from this source
[Guidance Overview]
June 4, 2015
"Some third party administrators (TPAs) and insurers currently have system or technical limitations that could affect an employer's approach to complying with the embedded self-only OOP maximum requirement. Therefore, an employer should consult with its claims administrator to determine if such limitations exist -- and if so, what plan design changes would be required.... Additionally, employers with carve-out benefits (e.g., prescription drugs) should ensure that the embedded self-only OOP maximums incorporate those benefits. Hospitals with multi-tier in-network benefits will also need to coordinate compliance with this OOP requirement across all in-network tiers."

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