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Open Enrollment Season: Best Practices for Employers

"[E]mployers, in tandem with their brokers/consultants, should plan out a checklist of tasks to complete before open enrollment actually begins.... As part of the preparation for a new plan year, employers cannot overlook the importance of ensuring they're still meeting all of their benefits compliance requirements.... [E]mployers should take steps to: [1] Communicate regularly and clearly with employees; [2] Provide straightforward, detailed descriptions of available benefits and costs; and [3] Stay on top of all enrollment deadlines."

Gag Clause Attestations: Digesting the Changes for 2026

"As employers, brokers, and advisors work through their fourth quarter compliance checklists, we cannot forget to include submission of GCPCAs as a necessary 'to-do.' It should surprise no one that this year, there are important changes to take notice of before the submission process begins."

The ACA Regulatory Roller Coaster Keeps on Moving

"The 2026 indexed affordability standard ... will see an increase to 9.96% of an employee's household income.... Applicable Large Employers (ALEs) could potentially increase employee premiums in 2026.... For 2026, an ALE that does not offer MEC coverage to at least 95% of their full-time employees ... may be assessed a $278.33 per full-time employee per month A penalty ... [S]ome employers run the numbers and decide to 'pay' for intentional noncompliance with the ACA's employer mandate instead of 'play' (i.e., comply with) the requirements.... ALEs that have decided the risk of the 'pay' approach is worthwhile may want to reconfirm that's still the approach they want to take."

Non-Enforcement of 2024 MHPAEA Final Rule Announced; Preexisting Requirements Remain in Place

"[T]he purpose of the comparative analysis is to provide further visibility into whether plans are compliant with MHPAEA. Whether the analysis is determined to be sufficient or not, if an agency audit determines that any financial requirements or treatment limitations do not comply with the parity requirements, the plan may be required to take corrective action (e.g., reprocess claims and refund participants when applicable). In addition, non-compliant plans could be subject to a penalty[.]"

Health Plan Compensation Disclosure Requirements Will Be a Positive Force for Employee Benefit Specialists and Consumers

"[The CAA] will require disclosure of commissions and consulting fees paid for welfare plans ... [This] will be good for our industry: [1] 'Clean hands' on cost transparency issues.... [2] Help employers put value on our services.... Employers knowing what we make promotes competition.... [4] Fix issues with cost disclosure for self-funded plans.... [5] What are you doing to earn your compensation? ... [6] Mitigate misaligned incentives."

Now and Yet to Come: Benefit Plan Changes Under the Consolidated Appropriations Act of 2021

"FSA relief is optional, and employers need to be intentional about if and how they do it and focus on employee communication.... Group health plans will need to annually perform compliance tests regarding any non-quantitative treatment limits that may apply to their mental health and substance use disorder coverage.... The law attempts to solve surprise billing beginning with plan years on or after January 1, 2021.... Employer plans will need to start tracking and reporting all of their enrollee information, their plan's geographic reach, and detailed pharmacy cost, claim, and rebate data.... All brokers and consultants will need to provide almost every group client with extensive compensation disclosures every year, beginning with plan years that start on or after January 1, 2022."

The Battlefield of Health Plan Fiduciary Litigation: Where Do We Stand?

"These cases underscore the tension between corporate governance, employee benefits, and the obligation of fiduciaries to act solely in the best interest of plan participants. They also illustrate the potential ripple effect of fiduciary litigation, prompting calls for transparency and prudent management ... But what exactly does it mean to be a prudent fiduciary? And how does one act in the best interest of the Plan and its participants?"

New Employer Reporting Regs Impact ACA Employer Mandate Penalties

"No Applicable Large Employer (ALE) wants to receive the dreaded 226-J letter issued by the [IRS] informing them of a proposed ACA employer mandate penalty. But, the good news is that employers will now have significantly more time to prepare a response before they need to consider requesting an extension."

Preventive Services vs. Preventive Care, What's the Difference?

"[T]he list of preventive services that most plans need to cover at $0.00 cost to participants under the ACA is more narrow than the list of care that QHDHPs may cover pre-deductible at no/reduced participant cost without risking participants' ability to contribute to an HSA.... Beyond what is required to be covered as preventive services under the ACA, the plan has flexibility to cover additional preventive care with no cost/reduced cost, but is not required to do so."

'Tis the Season for Employer Reporting

"ALEs need to ensure that their 2024 Forms 1095-C are provided to recipients by March 3, 2025.... Each ALE's Form 1094-C and Forms 1095-C must be successfully e-Filed and accepted by the IRS by March 31st, 2025.... particularly because the IRS eliminated the 'good faith' filing standard a few years ago that protected employers from various filing penalties, it's important for ALEs to ensure their ACA filings are as correct and comprehensive as possible."