Administration Stays Firm on Out-of-Pocket Rules

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Sept. 15 — An HHS rule on the annual limitation on cost sharing in group health plans that had employers worried won't be going away, the agency said.

In a Sept. 15 letter to the ERISA Industry Committee, a group that has been very vocal on the issue, the Department of Health and Human Services said that it won't be changing its rules stating that Affordable Care Act provisions that non-grandfathered group health plans not exceed cost-sharing limits apply to each plan participant regardless of whether the individual is enrolled in self-only coverage or not.

The agency's position was first indicated in a final rule issued by the HHS in February, which drew criticism for being only included in the preamble and not promulgated in separate rules. The position was solidified in subsequent guidance from the federal government.

Congressional Republicans expressed their displeasure with the rules in an August letter from Paul D. Ryan (R-Wis.), chairman of the Ways and Means Committee; Fred Upton (R-Mich.), head of the Energy and Commerce Committee; and John Kline (R-Minn.), chairman of the Education and the Workforce Committee.

ERIC's president and chief executive officer, Annette Guarisco Fildes, said in a Sept. 15 news release, “Last minute rule changes, especially those done without compliance with the Administrative Procedure Act, make it very difficult for employers to provide their workers with the best possible information and health plan options.”

She added that while ERIC hoped that the Obama administration would rethink its position, the lack of flexibility “will force many companies to raise premiums to offset this required plan design change.”

A copy of the letter to ERIC is at