By the Numbers: Your 2020 Health Plan Budget

Oct 14, 2019 | Compliance

Working on your 2020 health plan budget?  If so, you’ll want to keep the following limitations and penalties in mind.  The following apply as of the first day of your plan’s 2020 plan year:

Standard Plan In-Network Out-of-Pocket Maximums

  • $8,150 for self-only (employee-only) coverage
  • $16,300 for other than self-only coverage
  • Over these thresholds, employers must pay 100% of the benefits covered by the plan.

HSA Contribution Limits

  • $3,550 for individual with self-only (employee-only) HDHP coverage
  • $7,100 for individuals with other than self-only coverage HDHP coverage

High Deductible Health Plan Minimum Annual Deductibles

  • $1,400 for self-only (employee-only) HDHP coverage
  • $2,800 for other than self-only HDHP coverage
  • (Other than preventive, all services must be paid by employee until above thresholds are met, before the plan begins to pay for services.)

High Deductible Health Plan Out-of-Pocket Maximums

  • $6,900 for self-only (employee-only) HDHP coverage
  • $13,800 for other than self-only HDHP coverage
  • (Other than preventive, all services must be paid by employee until above thresholds are met, then employers must pay 100% of the benefits covered by the plan.)

Employer-Shared Responsibility Penalties

  • $2,570 per employee (for all employees combined) if qualifying coverage is not offered to 95% of the employer’s employees working 30 or more hours per week
  • $3,860 per each employee for whom the employer-offered coverage is deemed unaffordable

Affordability Safe Harbors

  • 78% – Employee cost-share for employer-offered coverage must be less than 9.78% of one of the ACA safe harbor amounts (federal poverty level, W-2 salary or hourly rate of pay) for cost-share to be deemed affordable. Note:  this is a decrease from the 2019 percentage.
  • $12,490 – Federal Poverty Level (FPL) Safe Harbor Amount

PCORI Fee Due July 31, 2020

  • No Filing Required for plan sponsors with plan years beginning on November 1, December 1, or January 1
  • $2.45 per covered life for all other plan years
  • A “covered life” means each and every individual covered under an applicable plan, i.e., employee, retiree, spouse, and dependent.

MedBen clients who have questions regarding these numbers are welcome to contact Senior Vice President Caroline Fraker at 800-851-0907 or cfraker@medben.com.