In order for a high deductible health plan to be qualified, what are the 2018 coverage requirements?

An individual is eligible to make or receive HSA contributions if they’re enrolled in a qualified high deductible health plan (HDHP).

In 2018, the HDHP is qualified if it meets the following criteria:

  • Has a minimum single deductible of $1,350 and a minimum family deductible of $2,700.
  • The out-of-pocket maximum is no greater than $6,650 for single coverage and $13,300 for family coverage.

Importantly, the family coverage cannot pay benefits for any single family member before the statutory family deductible has been met.

For example, let’s say that a HDHP has a self-only deductible of $1,700 and a family deductible of $3,000. The plan also has an embedded deductible within the family tier of coverage for any single family member who attains at least $1,700 in accepted claims. This plan would fail to be qualified and would render participants ineligible for HSA contributions. To correct the issue, the embedded deductible under the family tier would have to be at least $2,700 or the plan would have to eliminate the embedded deductible.

As an additional note, to be in compliance with the ACA, the family tier of coverage for any non-grandfathered policy (both qualified HDHPs and non-HDHPs) must include an embedded out-of-pocket maximum of $7,350 or less.