Among companies changing their rules regarding dependent eligibility, 49% say they're considering requiring dependents above a specified age to verify that they do not have access to other coverage, 20% are considering changing their premium tiers, 16% say they may charge higher premiums for all dependents and 12% are considering using more restrictive eligibility rules for their dental or vision coverage.

Cost increases triggered by the PPACA provisions would come on top of the regular annual cost hikes for health benefits, which Mercer notes have run about 6% a year over the last five years. Companies “have been working pretty hard at keeping the increase at that tolerable 6% average,” Umland notes. “Now if they want to stay at that level, they have to work that much harder.”

The excise tax to be imposed in 2018 was cited as the reform provision that worries them the most by 29% of the companies surveyed, followed by the extension of eligibility to adult children, which was cited by 20%, and the elimination of lifetime limits, cited by 21%.

Umland says that while the excise tax is a few years off, it could strike at the heart of some companies' approach to attracting and retaining employees. “The excise tax is pretty severe, 40% of the additional cost above the threshold,” she says. “Employers are going to work pretty hard to avoid that, and that could mean benefits plans are moving down toward a mean. If you have a strategy of using a plan as a way to get people and keep them, that's a change.”

A separate survey by Towers Watson found that while 90% of companies expect healthcare reform to increase the cost of providing health benefits, 46% say they will definitely continue to provide healthcare coverage and 42% say they're likely to continue providing health coverage.

For more about the adult dependent coverage requirement, see Under 26 Coverage?