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January 26, 2026

Benefits News to Know

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January 26, 2026

Compliance Reminders

  • February 2, 2026 – For employers with 250+ W-2’s, report health plans costs & furnish forms to employees
  • March 1, 2026 – Electronically submit via CMS’s website the Medicare Part D Creditable Coverage Form
  • March 1, 2026 – If a breach of PHI occurred in 2025, review whether reporting to HHS is required
  • March 2, 2026 – File Forms 1094/1095 with IRS (if paper filing) & furnish to employees (if providing paper statements) & post a clear notice to persons that they can request a copy of their form
  • March 2, 2026 – File Form M-1 with DOL if a Multiple Employer Welfare Arrangement (MEWA)
  • March 31, 2026 – File Forms 1094/1095 with the IRS (if filing electronically)

Coordination of Benefits: which plan pays first?

Group Health Plans are permitted to set Coordinate of Benefits (COB) Rules

“The general rule is that health plans can set their own provisions as to how to coordinate benefits among one or more other plans. An individual covered by two plans with dramatically different COB provisions could create confusion among the parties as to which plan will pay primary.”

Review the National Association of Insurance Commissioners COB model regulations, Section 6: MO120

These rules set by the NAIC are adopted by many plans as the foundation of their COB rules.

Fully Insured Plans: follow state guidance

“ERISA expressly preempts state laws that relate to ERISA employee benefit plans. However, one major exception from the general rule is that ERISA does not preempt any state insurance laws for a fully insured plan (the “Savings Clause”). Employer-sponsored group health plans that are fully insured must…comply with state insurance mandates, including state COB rules.”

Self-Funded Plans: Freedom to draft their own, with coordination

“Self-insured plans are not subject to any state insurance mandates because of ERISA preemption (the “Deemer Clause”). Employer-sponsored group health plans that are self-insured (including level funded) … are not subject to the mandates imposed by state COB rules. Many self-insured health plans… still follow the NAIC Model COB Rules to avoid confusion and conflict in their interaction with other plans. Where plan COB rules conflict, the plans will have to find some way to resolve their dispute…”

Quotes by Brian Gilmore, Read the full article .

ACA Reporting

ALEs must report to the IRS whether they offered full-time employees & their dependents the opportunity to enroll in minimum essential coverage under an eligible employer-sponsored plan, whether the offered coverage was affordable & provided minimum value, and certain other information that the IRS uses to administer employer shared responsibility and premium tax credits. This data helps the IRS determine if an ALE offers minimum essential coverage to at least 95% of full-time employees that is minimum value & affordable.

An ALE for a calendar year is an employer who employed (along with members of its controlled group) an average of at least 50 full-time employees (including full-time-equivalent employees) on business days during the preceding calendar year. Small employers under 50 full-time employees are not subject to employer shared responsibility penalties, but they may still face reporting penalties if they sponsor self-insured coverage. Source: Thompson Reuters, 2026

Deadlines: March 2 & March 31, 2026 - See Deadlines on page 2 & Access Instructions & Forms at the IRS

Are there penalties for a failure to file forms?

Yes. For 2025 returns & statements filed & furnished in 2026, the penalty for failing to file is increased to $340 per return. Failures corrected within 30 days result in reduced penalties of $60 per return or statement. Failures corrected by August 1 result in reduced penalties of $130 per return or statement. Special rules apply that increase penalties if there is intentional disregard of the requirement to file the returns and furnish the required statements. Source: Thompson Reuters, 2026

What employers should focus on in 2026:

The Employee Benefits Security Administration (EBSA) oversees investigations & enforcement of regulations that impact employer-sponsored benefits plans.The EBSA recently released its enforcement priorities. Employers should review these priorities & align existing benefit plans for maximum risk mitigation. The following are the top six enforcement projects, AKA, the issues investigators are focused on enforcing.

1. Cybersecurity – employers should evaluate & update HIPAA Rules’ policies & procedures.

2. Barriers to mental health & substance misuse disorder benefits – do your plans treat such benefits as equally as benefits for medical & surgical procedures? Don’t forget to update the Notice of Privacy Practices to include Part 2 language about substance misuse PHI. Read this blog.

3. Protecting benefit distributions

4. Retirement asset management

5. Surprise billing – this aligns with proposed regulations to strengthen transparency laws.

6. Criminal abuse of contributory benefit plans

Honorable mention: the EBSA will continue to identify abusive MEWAs from opening in other states.