January 29, 2021
All states
The proposed 2022 out-of-pocket maximum (OOPM) for group health plans is outlined below:
| Maximum OOPM for 2022 plan year | Maximum OOPM for 2021 plan year |
| Self-only: $9,100 | Self-only: $8,550 |
| Family: $18,200 | Family: $17,100 |
The OOPM is adjusted annually by the U.S. Department of Health and Human Services (HHS) and was released in the annual Notice of Benefit and Payment Parameters on Dec. 4, 2020. This represents about a 6.4% increase above the 2021 parameters of $8,550 for self-only coverage and $17,100 for other coverage.
The annual OOPM requirement applies to most non-grandfathered group health plans, regardless of whether the plan is fully insured or self-funded (ASO). It does not apply to grandfathered, transitional relief, and retiree-only plans. The OOPM includes copayments, deductibles, and coinsurance amounts associated with both medical and pharmacy covered benefits.
High-deductible plans with health savings accounts (HSAs) have different limits, including OOPM, deductible, and contribution limits. We are still awaiting Internal Revenue Service (IRS) final rules for 2022 HSA limits, historically released in May, and will communicate additional information once available.