SIIA Requests Delay in ACA Contraceptive Coverage Mandate Rule

Rule Will Disrupt Self-Insured Plans Sponsored by Religious Organizations      

November 26, 2013 – In a formal letter submitted today to the U.S. Departments of Health & Human Services, Labor and Treasury (“Tri-Agencies”), the Self-Insurance Institute of America, Inc. (SIIA) formally requested a delay in the effective date of the contraceptive coverage mandate rule related to self-insured religious organizations because of the complications it has created for their third party administrator (TPA) business partners.

The association explained that despite significant efforts by TPAs to comply with the final rule as contemplated, they are unable to do so. This will likely result in the termination of many self-insured plans sponsored by religious organizations starting in the next 30 days should a delay in the effective date not be issued.

The complete text of SIIA’s letter is provided below. Please watch for additional SIIA reporting on this developing story.

This action by SIIA comes on the same day that the U.S. Supreme Court announced that it will consider whether the rule is constitutional.

SIIA Letter to Tri-Agencies Regarding Contraceptive Coverage Mandate Rule

November 26, 2013

The Honorable Jacob Lew
Attention: Internal Revenue Service
U.S. Department of the Treasury
1500 Pennsylvania Ave. NW
Washington, DC 20220

The Honorable Thomas Perez
Attention: Office of Regulations and Interpretations
U.S. Department of Labor
200 Constitution Avenue NW
Washington, DC 20210

The Honorable Kathleen Sebelius
Centers for Medicare & Medicaid Services
U.S. Department of Health and Human Services
Attention: CMS-9954-P
P.O. Box 8016
Baltimore, MD 21244-8016

RE:           Contraceptive Coverage Mandate Rule – Request for Effective Date Delay

Dear Secretaries Lew, Perez and Sebelius:

The Self-Insurance Institute of America, Inc. (SIIA) respectfully requests that you delay the effective date of the contraceptive coverage mandate rule for qualified self-insured religious organizations. The reason for this time sensitive request is that we have concluded it is simply not possible for third party administrators (TPAs) to providing ongoing administration services for these organizations as contemplated by the rule.

The practical effect is that many of these self-insured group health plans will be terminated starting in about 30 days absent immediate action by your Departments.

SIIA TPA members are taking every conceivable action to comply with the final contraceptive mandate rule so this is not a matter of opposing rule for some political or ideological reason.   At issue is that there are no health insurance carriers willing to partner with TPAs to provide contraceptive service coverage for self-insured religious organizations.   It is also important to confirm that most TPAs do not maintain reserves sufficient to fund claims in anticipation of reimbursement on some uncertain future date, which has been suggested.

We trust that you do not want to see disruption in this important market segment, which will start occurring after January 1, 2014 absent immediate intervention. In this regard, SIIA respectfully requests that new regulatory guidance be issued either delaying the compliance or providing some other accommodation that would allow TPAs to continue to provide health plan administrative services for self-insured religious organizations.

We look forward to your prompt action given the time sensitive nature of this request.


Michael W. Ferguson