- IRS: 2025 Instructions (FINAL) for Forms 1094-C and 1095-C
- IRS: PCORI Fee Adjusted
- IRS: Access FINAL Forms 1094 & 1095 B&C Series at IRS website
- CMS: Gag Clause Prohibition Compliance Attestation Web Portal
- CMS: 2026 Medicare Parts A & B Premiums
- DOL: Self-Compliance Tool for Mental Health Parity Plan Testing
- Federal Register: Proposed Rule (Text) to Overhaul HIPAA Security Rule
- Editorial: Employers Grapple with GLP-1 Coverage for Weight Loss
- Blog: Dependent Care FSA for Employees on Leave
Compliance Reminders
Actions
Testing: Mental health parity & Nondiscrimination testing, as applicable, based on plan structure
By December 31
Submit Gag Clause Prohibition Attestation
Distribute Summary Annual Report
Gag Clause Prohibition Attestation Actions
The Gag Clause Prohibition Attestation is a component of the Consolidated Appropriations Act, a federal transparency law requiring health plan & health insurance issuers to submit an annual attestation by December 31st confirming their agreements do not contain language that would prohibit the sharing of certain data. In 2025, Federal Departments provided additional guidance for the 2025 annual attestation regarding which agreements are subject.
- Agreements includes the plan’s direct agreements with PPOs, TPAs, & providers.
- Attestation includes “downstream” agreements as well, e.g., TPA & their service providers.
- All plans must submit the attestation annually via CMS’s portal by December 31st
- Fully insured plans may rely on their issuer to submit to avoid duplication unless the carrier refuses. The plan is still responsible for ensuring submission.
- Self-funded plans must secure in writing that their TPA will submit the attestation if desired; the fiduciary responsibility remains with the plan to ensure compliance.
- Gag Clause Prohibition Compliance Attestation Web Portal
Instructions & Final Forms for ACA Reporting
- Employers with 50 or more employees (Applicable Large Employers ALEs) in the previous year must report data to both the IRS & individuals about their offers of, and enrollment in health coverage.
- Forms 1094-C & 1095-C are used in determining whether an ALE owes a payment under the employer shared responsibility provisions.
- Form 1095-C is used to report information about each employee to the IRS and to the employee & used in determining the eligibility of employees for the premium tax credit.
- Self-funded ALEs also use Form 1095-C to report data to the IRS & to employees about individuals who have minimum essential coverage under the employer plan.
- Self-funded non-ALEs will use the B series forms to submit data.
Employers no longer must automatically send Form 1095-B/C to individuals. The requirement for furnishing the statement is met if the entity responsible for providing the statements provides clear, conspicuous, & accessible notice on its website that an individual may request a copy of their statement, & the copy is timely furnished – i.e., provided to the individual no later than the later of January 31, 2026, or 30 days after the date of the request.
Benefits Question of the Month
What employees are counted for COBRA’s Small Employer Exception?
A group health plan is not subject to COBRA for any year if all employers maintaining the plan together employed fewer than 20 employees on a typical business day during the preceding year.
- Count all employees, not just plan participants
- Count only common-law employees – not self-employed, contractors, etc.
- Count part-time employees – each is a fraction of an employee
- Count employees of related entities & successors an employee – i.e., Controlled Group Rules
- Count employees & related entities outside the U.S. – U.S. employees working outside the country & employees of a foreign entity if counted as a member of a controlled group
Source: Thompson Reuters, 2025