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Employers still waiting for several key health reform issues to be resolved


While federal regulators have issued thousands of pages of rules to help employers comply with the Patient Protection and Affordable Care Act, several key issues have yet to be resolved.

At least one issue — whether private employers with religious objections to the use of birth control must cover prescription contraceptives — should be resolved soon.

The U.S. Supreme Court is expected to rule before its current term ends in June on suits filed by Conestoga Wood Specialties Corp., based in East Earl, Pennsylvania, and Oklahoma City-based Hobby Lobby Stores Inc., that argue the requirement violates their First Amendment right to freedom of religious expression and the Religious Freedom Restoration Act.

The outcome of the litigation is crucial to dozens, if not hundreds, of other private-sector employers that also object to providing prescription contraceptive coverage.

On the regulatory front, the timetable is less certain.

For example, under the law, a 40% excise tax is to be imposed in 2018 on health plan premiums — or premium equivalents in the case of self-funded plans — that exceed $10,200 for single coverage and $27,500 for family coverage.

Insurers for employers with fully insured plans and plan administrators for employers with self-funded plans would pay the tax, though experts expect insurers and TPAs would try to recover that money through higher premiums and assessments.

In addition, no guidance has been issued defining the types of health coverage to which the excise tax would apply.

“All the dots have not been connected. In terms of plan design, it is hard for employers to plan for the future without that guidance,” said Sharon Cohen, a principal at Buck Consultants L.L.C. in Washington.

Guidance also is lacking on a PPACA requirement that employers with at least 200 employees automatically enroll individuals who don't select coverage. However, regulators said the automatic enrollment requirement will not go into effect until rules are published.

Experts say such guidance currently is a low regulatory priority.