The ERISA Industry Committee (ERIC)
sent a letter to three federal agencies calling for the immediate
withdrawal of a newly proposed Affordable Care Act (ACA) cost-sharing rule.
In a letter to the Health and Human Services, Labor and
Treasury Departments, ERIC urged that a new out-of-pocket limit, proposed in what the Department of Labor (DOL) called
a “clarification”, for large group plans be stricken as it has no basis in law
and, in addition, broadsided employers with no real advance warning.
ERIC’s principal objection is that
the ACA clearly envisions two out-of-pocket limits for coverage in the 2016
plan year: one for self-only coverage ($6,850) and one for family coverage
($13,700). But in the new rule, the agencies imagine a third limit, which will
apply limits for individuals in family coverage.
"Instead of promulgating the rule in
sunlight under the usual comment period required by the Administrative
Procedures Act, the agencies made a significant policy change just months
before companies’ fall open enrollment periods begin, and as part of a largely
unrelated rule," ERIC says, noting that the proposal was made only in the preamble to the Health and
Human Services Notice of Benefit and Payment Parameters for 2016.
ERIC president and CEO Annette
Guarisco Fildes says in the letter that the impact of the proposed rule would
be “far-reaching,” as plan sponsors, insurance carriers and third-party
administrators would not have sufficient time to prepare their employees for
such “a significant and unjustified departure from the current rules.”
ERIC members by a wide margin—70%—said
they would be moderately or significantly affected by this rule change. At this
point in the year, companies “have already settled on at least a preliminary
pricing structure, including employee contributions, for 2016,” the letter
There’s much to dislike in the
newly proposed rule, Fildes says. “It suddenly burdens large employers with
cost-sharing responsibilities that will cause significant upheaval in their
benefit designs for next year, and instead of proposing the changes in broad
daylight, the agencies snuck the changes into the language of an unrelated
rule,” she says.
The full text of ERIC’s letter is on