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Business group lobbies against health care out-of-pocket rule change


An employer coalition is asking federal regulators to withdraw, or at least delay, a new health care reform law rule that places limits on how much in out-of-pocket expenses employers with high-deductible plans can require employees to pay.

Under that guidance, issued earlier this year by the U.S. Health and Human Services, Labor and Treasury departments, the maximum out-of-pocket expenses employees can be required to pay before health plan coverage kicks in will be $6,850 for single coverage and $13,700 for family coverage, when the rules take effect in 2016.

In addition, the guidance adds a new and potentially costly requirement for employers, who will have to cap at $6,850 the maximum out-of-pocket expense an individual with family coverage — whether an employee or covered dependent — can be required to pay before family coverage kicks in.

Specifically, the $6,850 annual cap on how much a plan participant can be required to pay will apply regardless if the individual has single or family coverage.

The National Coalition on Benefits in a letter sent Thursday to the HHS, Labor and Treasury Department secretaries said the new requirement “was done without statutory justification and appropriate rulemaking process.”

Many companies “are unaware that this policy change has been made. This new requirement isn't codified, and clarification of its application to the larger group market comes at a very late date in the process,” according to the coalition letter.

A key part of the nation's health care system is the ability of employers to provide health care coverage to their employees, the letter says.

“However, this system cannot continue if employers are not provided with the regulatory consistency, simplicity and predictability necessary to continue to provide high-quality, cost-effective benefits to their employees and their families,” the letter said.

The coalition told regulators that the requirement should be “withdrawn immediately,” or at minimum delayed until the 2017 plan year.

Coalition members include such well-known benefits trade groups as the American Benefits Council, the ERISA Industry Committee and the National Business Group on Health, as well as dozens of individual companies, including AT&T Inc., Caterpillar Inc., Fed Ex Corp. and Xerox Corp.