Deductibles and out-of-pocket maximums (OOPMs) are important cost-sharing parameters for health plans. This compliance overview summarizes key rules for employers regarding these limits, including the special limits for high-deductible health plans (HDHPs) and the Affordable Care Act’s (ACA) OOPM on essential health benefits.  [Download the full PDF report]   Understanding deductibles and OOPMs  Deductibles and OOPMs play a central role in how health plan costs are shared between the plan and the enrollee. Here’s  important terms employers need to know:  Deductible: The amount a member must pay out-of-pocket for covered services before the health plan begins to contribute.  Out-of-Pocket Maximum (OOPM): The annual cap on what a member pays for covered services. Once reached, the health plan covers 100% of additional covered costs for the rest of the year.  Premium trade-off: Plans with higher deductibles and OOPMs often come with lower monthly premium...

The Affordable Care Act (ACA) requires health insurance issuers and self-insured plan sponsors to pay Patient-Centered Outcomes Research Institute fees (PCORI fees) annually, using IRS Form 720. This update provides an overview of Form 720 and full payment of the PCORI fees, which are due by July 31 for plan years ending in 2024.   [Get the whole PDF update here]   Key details to keep in mind  Annual filing: PCORI fees must be reported and paid using IRS Form 720, the Quarterly Federal Excise Tax Return.  Upcoming deadline: For plan years ending in 2024, the payment and filing are due by July 31.  Coverage period: Fees apply to plan years that ended during the previous calendar year.  Who must pay: Both fully insured and self-insured group health plans may be subject to the fee, with filing responsibility typically falling on the employer for self-insured plans.  Employers should review their plan year end dates and ensure timely compliance to avoid p...

Welcome to the July 2025 edition of Benefits Buzz! In this month’s issue, we dive into the latest topics related to employee benefits, wellness programs and ever-evolving workplace dynamics. Stay informed and gain insights that help you make the most of your benefits package.  This month's topics  Topic #1: U.S. Supreme Court upholds state ban on gender-affirming care for minors.  Topic #2: PCORI fees are due by July 31.  Download the full issue  For an in-depth look at this month's topics, download the PDF below. Dive deeper into the advice and guidance that can help you leverage your benefits to their fullest potential. Don't miss out on valuable insights that could improve your professional and personal life.  [Download the Full Story PDF]   Stay informed, stay empowered and make the most of your benefits with Benefits Buzz! Be sure to follow us on LinkedIn for monthly updates and never miss out on the latest in benefits news.  Questions?...