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Summary of benefit rules leaves one major area unaddressed: Cadillac tax

Summary of benefit rules leaves one major area unaddressed: Cadillac tax

Final rules on the annual summary of health care benefits and coverage that employers must provide to their employees marks the end of significant new health care reform law regulations and guidance, with one exception.

The notice on the summary of health benefit coverage — issued jointly last week by the Departments of Health and Human Services, Labor and Treasury — closely follows guidance issued last month.

Under the final notice, the new summaries will not have to be distributed until the first day of health plan open enrollment periods that begin on or after April 1, 2017.

Since most employers have plan years that begin on the first day of the year, employers typically will have until Jan. 1, 2018, to distribute the notices.

“Employers are being given plenty of time to prepare,” said Steve Wojcik, vice president of public policy at the National Business Group on Health in Washington.

The final rules require employers to give examples of how coverage applies in three specific situations: having a baby, managing Type 2 diabetes and treating simple fractures. Employers also will have to provide examples of the costs of treatment for those three situations.

The notice brings nearly to an end years of development of thousands of pages of guidance to help employers comply with the Patient Protection and Affordable Care Act of 2010.

“We are nearing the end of the regulatory” development stage, said James Gelfand, senior vice president of health policy at the ERISA Industry Committee in Washington.

The one exception is the 40% excise tax, also known as the Cadillac tax, that is to be imposed on health plan premiums that exceed $10,200 for single coverage and $27,500 for family coverage. Since that tax has been delayed until 2020 and congressional sentiment has been building to repeal it, it is unlikely that guidance will arrive anytime soon, experts say.

“With the possible exception of the excise tax, no major ACA regulatory guidance is expected this year,” said Rich Stover, a principal at Xerox HR Services in Secaucus, New York.

The outcome of the presidential race could be a factor in the future of the excise tax. All three Republican contenders back repealing ACA. Democrat Hillary Clinton says the excise tax should be scrapped, while fellow Democratic contender Sen. Bernie Sanders, I-Vt., wants to scrap the ACA and replace it with a single-payer national health insurance system.

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