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As annual open enrollment season approaches, many employers may be evaluating ways in which to control rising health plan costs. One strategy frequently considered is a financial incentive for employees to waive or opt out of the employer-sponsored group health coverage. Although such “cash-in-lieu” or “opt-out” arrangements have long been common, they raise potential problems under the Affordable Care Act (ACA), as well as a number of other federal laws.
The ACA 'Employer Payment Plan' Issue
Often, opt-out payments are conditioned on an employee's proof of other health coverage. The first ACA issue arises if such arrangements are structured as premium reimbursements for individual health insurance, whether purchased on the open market or through a public exchange. This is because the regulators have said that, by paying or reimbursing employees' individual health insurance premiums, an employer establishes an “employer payment plan.” And by its terms, such a plan violates the ACA. This is because it does not comply with the ACA rules prohibiting lifetime or annual limits on essential health benefits and mandating coverage for specified preventive-care services.
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