As the new year approaches, many employers and HR professionals are focused on preparing for health plan renewals and compliance obligations. While some requirements are tied to specific calendar dates, the majority align with the January 1st renewal cycle, making this a critical time to ensure all details are in place. From gag clause attestations to HIPAA updates, neglecting these tasks can lead to compliance issues and penalties. To help employers navigate this complex process, we’ve compiled a checklist of essential requirements to review before the year ends.
Many of these requirements do not necessarily coincide with specific calendar dates, but since the majority of health plans renew as of January 1st, there are several requirements that tend to get overlooked at this time of year.
1. Gag Clause Prohibition Compliance Attestations: All group medical plans, both fully insured or self-insured, regardless of size, must submit an attestation confirming that their contracts with service providers contain no “gag clauses”. Attestations are due by December 31, 2024, and each year by December 31 for the prior plan year.
2. Open Enrollment Rights: Employers must notify several unique groups of their right to change coverage elections during open enrollment (as they have open enrollment rights similar to active employees):
- Individuals enrolled under COBRA (or still in their COBRA election window)
- Those on state continuation (if applicable), including spouses or dependent children
- Employees out on FMLA or other approved leave, either paid or unpaid
3. HSA Eligibility:
- Employers must ensure that individuals enrolled in a general-purpose health FSA or any other disqualifying coverage (such as Medicaid or Medicare) does not open and contribute to an HSA. As a reminder, a health FSA, including a spouse’s FSA, is considered disqualifying coverage that makes an individual ineligible for an HSA.
- Employers wishing to offer ‘first-dollar’ telehealth coverage may take advantage of the CAA 2023 relief for the 2023 and 2024 plan years. There is expectation that relief will extend to 2025, but until Congress officially extends, 2025 plans must charge a fair market value for telehealth visits until the plan participants meet their federal minimum deductible.
- Be sure embedded per-person deductibles increase from $3,200 to $3,300 for 2025.
4. Notices:
Distribute required notices, including a Summary of Material Modifications (SMM) if any changes are made to the plan document/SPD.
5. Proof of Dependent Status: If proof of dependent status is requested by the employer, either a signed employee attestation or documentation (e.g., marriage license, birth certificate, tax return, etc.) is required for everyone on the same terms. In other words, the types of documentation requested should not vary from employee to employee.
6. Updates to HIPAA Policies & Procedures: Public agency or law enforcement officials requesting PHI potentially related to reproductive health care must complete a new attestation form starting December 23, 2024. Employers need to update policies/procedures with this new requirement and train appropriate employees on how to follow the new processes.
7. FSA Tasks:
- For a health FSA with a debit card, the employer needs to resolve any lingering unsubstantiated claims. Employees who cannot provide a valid receipt MUST repay the plan for improperly using plan funds, as they are not allowed to cash out use-it-or-lose-it funds for non-medical expenses.
- Non-discrimination testing should occur toward the end of the plan year (preliminary testing earlier in the plan year is strongly encouraged to set the end-of-year testing up for the greatest chance of passing).
- An FSA plan document that does not reference statutory indexing of limits must be amended with any increased limits.
8. 5500 Determination: As of the first day of the plan year, employers need to determine whether they need to file Form 5500 for the current plan year. To do so, they need to count the exact number of plan participants enrolled, not including dependents, on the first day of the plan year. So, if the employer sponsors an employer-paid basic life plan that automatically includes all eligible employees, be sure to use the life plan enrollment for the count. Plans with under 100 participants are exempt from filing Form 5500 if unfunded, fully-insured or both.
9. Applicable Large Employer (ALE) Determination:
Employers must confirm if they are an applicable large employer, and therefore subject to the employer mandate for the current year by calculating the number of employees during the calendar year that just ended. Employers with 50 or more full-time employees plus full-time equivalents must offer coverage to full-time employees and also file ACA reporting electronically with the IRS. For reference, the IRS Website provides resources to assist with ALE calculation.
Compliance with these requirements is not just about avoiding penalties—it’s about maintaining trust and providing seamless benefits to employees. By addressing these key tasks and staying informed of regulatory updates, employers can set the tone for a successful benefits year. If you have questions about any of these requirements or need assistance with your compliance efforts, our team is here to help. Don’t hesitate to reach out as we work together to ensure your health plan obligations are met.