Business Group Urges Washington to Withdraw New Health Insurance Rule

For Immediate Release

Washington, DC – The ERISA Industry Committee (ERIC) today 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 (OOP) limit proposed (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 (OOP) 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 individual limits in family coverage.

The agencies, instead of promulgating the rule in sunlight under the usual comment period required by the Administrative Procedures Act, made a significant policy change just months before companies’ fall open enrollment periods begin, and as part of a largely unrelated rule. 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 to the agencies 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.”

In a recent poll, ERIC members, by a wide margin – 70 percent – said that they would be moderately or significantly affected by this rule change. At this point of the year companies “have already settled on at least a preliminary pricing structure, including employee contributions, for 2016,” the letter states.

There’s much to dislike in the newly proposed rule, says Guarisco Fildes. “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.”


All media inquiries to The ERISA Industry Committee should be directed to:

Kelly Broadway, 202.627.1918,

About the ERISA Industry Committee
ERIC is the only national association that advocates exclusively for large employer plan sponsors on health, retirement, compensation, and paid leave public policies at the federal, state, and local levels. With member companies that are leaders in every sector of the economy, ERIC promotes uniformity and flexibility for nationwide benefit plans.