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With renewals and open enrollment top of mind for many employers, we’re adding an annual checklist of compliance items for a group health plan year-end review. 

Disclaimer: This is not an exhaustive list, rather a summary of notable requirements.

Open Enrollment Materials

• Provide COBRA qualified beneficiaries information regarding the upcoming group health plans (medical, dental, vision).
  • Cobra participants have the same open enrollment rights as active employees to add coverage, add dependents to coverage, and/or change plans.
• Distribute federally mandated notices to employees.
  • Open enrollment materials should always include the Summary of Benefits and Coverage (SBC) for each medical/Rx plan you sponsor, and there’s a new foreign language county list for 2025 SBCs.
  • The CHIP, WHCRA, and Part D creditability notices are also important to provide during open enrollment.
• Hospital indemnity and other per-day or per-period indemnity plans have a new notice requirement.

Affordable Care Act (ACA)

• Applicable large employers (ALEs) should ensure the lowest cost single plan providing minimum value meets one of the three affordability safe harbors.
• ALEs utilizing the lookback method need to offer medical to non-full-time employees who measure into a full-time stability period.
• Prepare to provide accurate ACA reporting for the 2024 calendar year due in March of 2025.

Section 125/Health Flexible Spending Accounts (FSAs)

• If your health FSA plan documents do not reference automatic IRS indexing, amend your health FSA to adopt the 2025 increased employee contribution limit of $3,300.
• Help your health FSA administrator resolve unsubstantiated debit card claims before the end of the year.
  • Employees who fail to provide receipts owe the plan a debt, which the employer may need to handle by asking the employee to authorize extra after-tax paycheck deductions.
• Conduct annual non-discrimination testing at the end of the plan year
  • Many employers only run a preliminary test halfway through the year, but the rules technically require testing at the end of the year to account for all new hires and terminations.

Health Savings Accounts (HSAs)

• Verify annual figures comply with 2025 indexing
  • It’s especially important that embedded per-person deductibles for family coverage are at least $3,300 per person
• List of HSA-qualified preventive care services has expanded, employers may want to amend the medical plan to treat those as no-cost preventive care.
• Check for low- or no-cost telemedicine or COVID benefits that are payable before individuals have met their federal minimum deductible.
  • Plan years ending in 2024 are the last allowed to pay for COVID testing and treatment before the deductible.
  • Plan years starting in 2024 are the last allowed to charge low or no cost for telemedicine before the deductible (unless Congress extends this again, which seems plausible as there is strong bipartisan support).

Plan Design Changes

• The HSA reminders addressed above apply to your HSA-qualified high deductible health plans (QHDHPs).
• Ensure 2025 preventive care updates are adopted (your carrier/TPA/PBM keeps tabs on these federal mandates as they’re updated).
• Mental health parity is a top priority for Congress and DOL enforcement, so employers should be diligently ensuring:
  • Their 2025 plan will provide sufficient network access to mental health and substance use disorder providers
  • Autism spectrum disorder (ASD), eating disorders, and gender dysphoria must all be proven to be in parity.
  • If a non-quantitative treatment limitation (NQTL) does not apply to medical/surgical benefits in a classification, then it cannot apply to MH/SUD benefits in that classification.
  • A comprehensive parity and NQTL analysis must be completed and personally reviewed with plan fiduciaries who must certify diligence.

Federal Transparency Efforts

• Ensure written agreements between the employer and claims administrator address responsibility and liability/hold harmless language with respect to the numerous transparency requirements.
  • Verify who will be completing RxDC reporting by June 1, 2025, and whether the employer has any responsibilities/deadlines to ensure it will be done.
  • Verify all provider contracts and service agreements are free of prohibited gag clauses, who will be completing the annual gag clause prohibition compliance attestation (GCPCA), and whether the employer has any responsibilities/deadlines to ensure it will be done.

Please let your IMA Benefits team know if you have questions.

IMA will continue to monitor regulator guidance and offer meaningful, practical, timely information. This material should not be considered as a substitute for legal, tax and/or actuarial advice. Contact the appropriate professional counsel for such matters. These materials are not exhaustive and are subject to possible changes in applicable laws, rules, and regulations and their interpretations.

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