Closing Out 2024 and Preparing for 2025

Within 90 Days of Receipt

Medical Loss Ratio (MLR) Rebate Distribution Deadline

(for fully insured health plans that receive an MLR Rebate)

To avoid additional compliance obligations, fully insured health plans that receive a Medical Loss Ratio (MLR) Rebate must disperse/spend the portion deemed ‘plan assets’ no later than 90 days from its receipt. Likewise, plans that meet the criteria for a governmental plan or church plan ERISA exception are required to similarly disperse/spend the portion of the any rebatethat would have been plan assets had the plan been subject to ERISA.

If you receive an MLR rebate from your health insurer, please review any accompanying attachments carefully and, when in doubt, review Technical Release 2011-04. The rebate distribution guidelines found in your plan documents and SPDs should also be consulted, when applicable.

2025 Open Enrollment

(actual date varies by plan year)

Fixed Indemnity Excepted Benefits Coverage (FIEBC) Notice Reminder

(for Hospital Indemnity and other fixed indemnity insurance)

New for 2025 plan years, aFixed Indemnity Excepted Benefits Coverage (FIEBC) Noticemust be provided at or before the time participants are given the opportunity to enroll in Hospital Indemnity or "other fixed indemnity insurance" coverage (not to include most Critical Illness and Accident plans). In addition to having to be in included in any written policies and marketing materials, they also must be included in "any documents or website pages that advertise the benefits or offer an opportunity to enroll (or reenroll) in group market fixed indemnity excepted benefits coverage." Common locations where the notice therefore may need to also appear include benefit booklets or enrollment/benefits guides (particularly when they are the only marketing or information about the plan that employees see before enrolling) and on any online enrollment platforms (e.g., Ease,bSwift, Employee Navigator, etc.).

For important details on this new notice, please read our summary here. A Frequently Asked Questions document is also available here.

22

December

HIPAA Privacy & Security Material Update Deadline, Pt. 1

(for Self-funded health, dental, and vision plans, including Level Funded plans, FSAs, and HRAs, and fully insured plans with access to PHI)

HIPAA Covered Entities must update their Privacy & Security administrative policies by Dec. 22, 2024, to address the new category of prohibited disclosure and use of Protected Health Information related to reproductive health care. The plan’s HIPAA Notice of Privacy Practices must also be updated to reflect these changes, but that is not required until February 16, 2026.

31

December

COVID-19 Testing and Treatment Sunset Reminder

(for employers and other plan sponsors who offer HDHPs)

Per IRS Notice 2023-37, thetemporary relief allowing High Deductible Health Plans (HDHPs) to provide first-dollar coverage for COVID-related testing and treatment without affecting the participants' status as an HSA Eligible Individual will only apply to plan years ending on or beforeDecember 31, 2024. Failing to make such services subject to the plan's deductible and coinsurance for subsequent plan years will cause participants to no longer be HSA Eligible Individuals, even if such benefits are not actually utilized.

31

December

CAA Gag Clause Attestation Deadline

(for health plans and/or standalone or carve out benefits which include access to a provider network)

Health plans and insurers are required to submit their annual Gag Clause Prohibition Compliance Attestation (GCPCA) by December 31, 2025. While most fully insured health plans will be able to rely on their insurers to submit the GCPCA on the plan’s behalf, self-funded and level funded group health plans will need to enter into a written agreement with their TPA to handle it for them (if that is a service their TPA is willing to provide). In cases where health plans enter into contracts with providers directly, the employer/plan sponsor may need to submit the GCPCA themselves. This includes standalone and carve-out health-related benefits, including Behavioral Health Plans, Telehealth Plans, Direct Primary Care programs, transplant programs, Specialty Rx Plans, and EAPs/Employer Wellness Programs that provide significant medical care.

Plans that are not subject to attestation requirements include ICHRAs, HRAs, FSAs, HSA bank accounts, HIPAA Excepted Benefits (such as standalone dental/vision/LTC plans, most Cancer/Critical Illness worksite benefits, on-site medical clinics, and EAPs/Employer Wellness Programs that do not provide significant medical care. It does not apply to stop-loss insurance, Workers Comp benefits, nor HSA bank accounts.

31

December

Formal Request of Missing SSN Deadline

(for employers who file IRS Form 1095-series forms)

Employers who submit 1095-series and other IRS forms with missing or incorrect TIN/SSNs and who do not have proof of their “reasonable effort” to obtain or correct it are subject to a $50 per-instance IRS penalty. The timing of what constitutes a "reasonable effort" depends on whether the SSN is missing vs. reported as incorrect.

• Employers and plan sponsors should solicit missing SSNs (e.g., for a newborn who was enrolled without a SSN) no later than 75 days after first enrollment, and if the SSN is still missing, then again on or before December 31 of the following year.
• Employers and plan sponsors who received "Accepted with Errors - Name/TIN Mismatch" with their 1095-C filings should solicit corrected SSNs no later than December 31 of the year in which the error notification was received (or by January 31 if the relationship began in December). If unsuccessful, a second annual solicitation should occur no later than December 31 of the following year.

1

January

(or first day of the 2025 plan year, if later)

Mental Health Parity Final Rule Reminder, Part I

(for health plans subject to the MHPAEA with mental health and substance use disorder benefits)

Many of the newly modified final rules under the Mental Health Parity and Equity Act (MHPAEA) are effective the first day of the plan year beginning on or after January 1, 2025. While these changes affect plans with mental health and substance use disorder benefits (unless a stand-alone retiree plan or eligible for a small-plan exception), plans subject to ERISA will now have an additional obligation to certify that they engaged in a prudent process to scrutinize and vet their third-party administrators and PBMs to make sure they are compliant with the MHPAEA. Self-funded plans are also responsible for building, updating, and maintaining their Nonquantitative Treatment Limitation (NQTL) Analysis to comply with the Final Rule. Exempt from these requirements are small employers who employed 50 or fewer employees on business days during the previous calendar year (or, if a Governmental Plan, fewer than 100 employees).

Additional requirements related to the Final Rule apply in 2026.

1

January

(or first day of the 2025 plan year, if later)

Mental Health Parity Final Rule Reminder, Part I

(for HDHP plans that wish to preserve HSA compatibility)

The temporary pandemic-related relief allowing High Deductible Health Plans (HDHPs) to pay first-dollar (or below-market-rate) telehealth and remote care services before meeting the deductible ends for all plan years beginning on or after January 1, 2025. Unless Congress extends this relief, plans wishing to preserve a HDHP’s HSA compatibility must amend the plan as of the first day of the 2025 plan year. Conversely, plans that continue to allow such services must notify participants that it is no longer an HSA-compatible, qualified HDHP.

1

January

ADA, COBRA, and ACA “Applicable Large Employer” (ALE) Eligibility Check Reminder

Employers hovering around 15 employees (for the ADA), 20 employees (for COBRA), or around 50 full-time/full-time-equivalent employees (for the ACA's applicable large-employer requirements) during 2024 should perform their annual check to see if they are subject to any or all of these laws for 2025. Special rules apply to employers with significant common ownership or control under the Controlled Group and Affiliated Service group rules.

Plans newly subject to COBRA will need to provide notice to all participants within 90 days.

1

January

State/Local Mandate, Reporting, and Benefit Law Check Reminder

(specific deadlines vary)

Employers are required to stay abreast of which health and welfare benefit-related rules apply to them specifically due to their employees' worksites or states of residence. For example, California, Massachusetts, New Jersey, Rhode Island, and Washington D.C. all require employer health coverage reporting, while California has an annual notice requirement for FSAs, DCAPs, and adoption assistance FSAs. California, Hawaii, New York, New Jersey, Rhode Island, and Puerto Rico also mandate certain disability coverages in addition to the various Workers' Compensation requirements that apply. Further, Illinois requires employers in all states to provide a DDCA notice. In addition, cities such as San Francisco, Philadelphia, Washington D.C., Chicago (and its surrounding counties), and numerous others have commuter benefit and other mandates in place. These ever-changing rules should also be revisited each time an employee is hired in a new state or locality, as applicable.

15

January

2024 Comparability Rule Notice Deadline

Employers who provide HSA bank account contributions OUTSIDE of their Section 125 Cafeteria Plan must provide a written "Comparability Notice" to any employee or former employee who is in danger of forfeiting such contributions because they have either not opened an HSA Trust (bank) account or because they have not properly informed their employer of such account information by the last day of the tax year (i.e., December 31, 2024).

This notice is not required for employers who provide HSA bank account contributions that are run through their Section 125 Cafeteria Plan (i.e., they are expressly permitted by the Section 125/POP plan documents), however many feel that sending a forfeiture warning letter is still a good practice.

31

January

HSA, Dependent Care, and Cost of Health Coverage W-2 Reporting Deadline

Employers have many benefits-related reporting obligations on W-2s, Schedule K-1s, and other tax forms, as applicable. Among other requirements, this includes employer HSA contributions and employee HSA dollars withheld on a pre-tax basis (which must be reported in Form W-2, Box 12 using Code W), the Table 2-2 cost of group term life coverage over $50,000 (reported in Box 12 using Code C), and the total dependent care benefits paid or incurred on an employee's behalf (in Box 10 and/or in Box 1 if the plan is found to be discriminatory in favor of Highly Compensated Employees/5% owners, or above the allowed maximums, etc.). In addition, tax reporting may be required for benefits provided to Domestic Partners/Parties to a Civil Union and their dependents, dependent children over the age of 26, and others who do not also qualify as a Code §105(b) tax dependent. Finally, employers who issued 250 or more W-2s for the preceding calendar year generally must include the total annual cost (incorporating both employee and employer contributions) of any health coverage provided in box 12 using Code DD.