Compliance Resource Center

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 and 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 and Employer Wellness Programs that do not provide significant medical care).  It also does not apply to stop-loss insurance nor Workers Compensation benefits.

Deadline for Missing or Corrected Names/SSNs
(for employers who file IRS Form 1095-series forms)

Employers who submit 1095-series and other IRS forms with an incorrect name or SSNs (e.g., discovered after receiving an IRS ‘mismatch error’ notice) are subject to a $50 per-instance IRS penalty unless they can document their reasonable efforts to obtain it.  Upon notification of a mismatch, a formal follow-up request must be made to the primary insured no later than December 31 of the year in which the mismatch is discovered (automatically extended to January 31 if the relationship begin in the month of December).  If no response is received and the record is still incorrect, the corrected name/SSN must be requested yet again, this time no later than Dec. 31 of the following year.

Other deadlines may be approaching for your plan.