The ACA requires large employers that sponsor fully insured or self-insured (including level funded) group health plans to report information to the IRS annually via Form W-2 regarding the cost of health coverage provided to employees during the prior calendar year. If PPI billed your medical plan during the reporting year, the Cost of Coverage report, found in your PPI Connect Portal, can be very helpful for completing this requirement.

Under prior guidance, the Forms 1095-C must be delivered to full-time employees by March 3, 2025, by mail, hand delivery, or electronic delivery (the latter only if proper consent in accordance with IRS instructions). However, under the Paperwork Burden Reduction Act (PBRA), which was recently enacted, employers have the option to provide Form 1095-C to such employees only upon request.

This legislation makes certain modifications to the ACA’s employer mandate reporting requirements that aim to simplify Forms 1095-B and 1095-C reporting for employers and health insurance providers

the CAA prohibits group health plans and insurers from directly or indirectly entering contracts offering access to provider networks that contain certain types of “gag clauses.” The CAA requires plans and insurers to annually attest to compliance with its gag clause prohibition for contracts entered since the first attestation made in 2023.

On October 22, 2024, the IRS issued Revenue Procedure 2024-40, providing certain cost-of-living adjustments for a wide variety of tax-related items, including health FSA contribution limits, transportation and parking benefits, qualified small employer health reimbursement arrangements (QSEHRAs), the small business tax credit, and other adjustments for tax year 2025. Those changes are outlined below.

The deadline for 2024 CAA gag clause attestations is just around the corner. Employers should act now to ensure their group health plan contracts are compliant and attestations are timely submitted.

Employers of all sizes that sponsor prescription drug plans (whether fully insured or self-insured) are required to annually inform Medicare eligible individuals whether the plan’s coverage is “creditable” or “non-creditable.”

The ACA requires insurers to submit an annual report to HHS to account for plan costs. If the insurer does not meet the medical loss ratio (MLR) standards, this means that too large a portion of the premiums charged in the previous year went toward the insurer’s administration, marketing, and profit instead of going toward paying claims and quality improvement initiatives.

The ACA imposed the PCOR fee on health plans to support clinical effectiveness research. The PCOR fee, which applies to plan years ending on or after October 1, 2012, and before October 1, 2029, is generally due by July 31 of the calendar year following the close of the plan year. PCOR fees must be...

The CAA, 2021 requires fully insured and self-insured group health plans to annually report certain information regarding prescription drug and healthcare spending to CMS. Reporting for the 2023 calendar year (termed the “reference year”) is due by June 1, 2024.