Robert B. wrote:

- quote -

Yes. The law is clear that the policy has to limit out of
pocket expenses to $5,000 for individual and $10,000 for
family coverage. Your policy would not meet that test--the
policy would either need to lower the deductible *OR* pay
100% once the two of you went over $10,000 in expenses.

As to why that is the rule--ask your Congress-critter.

--
Ed Zollars, CPA
Phoenix, Arizona

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"Robert B." <nospam[at]spamnot.net> wrote:

- quote -

"Out-of-pocket" limits typically DO NOT include your
deductible, but are in excess of that.

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Can someone translate the following eligibility Health
Savings Account eligibility requirements for me
(http://tinyurl.com/3ebtv):

"Allowable deductibles have been lowered to $1,000 for an
individual and $2,000 for a family. The maximum deductible
requirement has been replaced by maximum out-of-pocket
limits of $5,000 for individuals and $10,000 for families.
These limits include deductibles and coinsurance for
"in-network" providers. These amounts will be adjusted
annually for cost of living increases. There is no
restriction on the stop-loss limits for out-of-network
services."

My wife and I have a high deductible policy with $10,000
deductible per year per person which easily meets the
minimum allowable deductible requirement. My question is
about the "maximum out-of-pocket limits" which look to be
lower than my deductibles. IOW, both my wife and I are
potentially on the hook for $12,500 per year medical
expenses (10K deductible + 2.5K co-insurance max) which is
in excess of the "maximum out-of-pocket limits".

It looks to me like our plan may not be eligible. Am I
reading this right?

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