- IRS: 2027 Health Plan Affordability Percentage increases to 10.22% -Rule Text
- Proposed Rule for Health Plan Electronic Disclosures: DOL’s News Release & Proposed Rule Text
- DOL: If You See the Following in Written Plan Provisions or Plan Operations, Think Twice
- Blog: DOL warns employers of tobacco wellness program rule conflict
- Blog: DOL secretary nominee calls PBM transparency a 'priority'
- Blog: DOL names mental health parity at open enforcement priority
- Blog: OTC birth control coverage mandate bill revived by House
- CMS: CMS Rebrands ICHRAs to CHOICE Arrangements – Employer Initiatives
Compliance Deadlines
- October 3, 2026 – provide ICHRA & QSEHRA notices for 2027 plan year; ICHRA model notice template
- October 14, 2026 – provide Medicare Part D Creditable Coverage notices. Model notice at CMS
- December 15, 2026 - Provide Summary Annual Report (extended deadline for 1/1 plans)
- December 31, 2026 – Submit Gag Clause Prohibition Attestation via CMS’ portal
Q&A: Employers: Prepare for PBM Reform
Question: We heard that a new law requires that employers make certain disclosures to participants & beneficiaries about our group health plan’s arrangement for pharmacy benefit management services. Is this true?
Answer: The Consolidated Appropriations Act, 2026 (CAA, 2026) contains detailed disclosure requirements that apply to contracts between group health plans or insurers & pharmacy benefit managers (PBMs) for plan years beginning on or after August 3, 2028.
- While provisions address disclosures from the PBM to the plan or insurer, there are elements that involve disclosures from the plan or insurer to participants and beneficiaries.
- Annual Notification. Participants and beneficiaries must be notified annually about the requirement that PBMs submit reports to the plan.This may be accomplished by incorporating the notification in to other plan documentation provided to participants and beneficiaries or by providing individual notification.
- Disclosures Upon Request. Among the materials required to be provided by the PBM to the plan or insurer is a summary appropriate for participants and beneficiaries, which the plan or insurer must furnish to a participant or beneficiary upon request. For a participant’s or beneficiary’s own claim, the plan or insurer must disclose, on request, the difference between the amount paid by the plan or insurer to the PBM (or other applicable entity) for the covered drug and the amount paid by the PBM (or other applicable entity) to the pharmacy for that drug.
Disclosure requirements will apply for plan years beginning on or after August 3, 2028; plan administrators should keep the requirements in mind for planning purposes, as revisions to service agreements & participant communications will be needed.
Source: Contributing Editors: EBIA Staff. © 2026 Thomson Reuters/EBIA. All rights reserved
Prioritize Benefits Planning:
5 Compliance Items for Employers & Advisors
As open enrollment approaches, employers& their advisors can use this quick guide as a starting point to prioritize key compliance updates, plan design decisions, employee communications, ACA reporting steps, and recurring year-end deadlines. By Eboni Onuoha, Esq., Benefits Compliance Counsel
2026 Indexed Limits
- What Changed? What to Know: HSA, HDHP, health FSA, dependent care FSA, and ACA out-of-pocket limits increased in 2026.
- Employer Takeaway: Update enrollment materials, payroll systems, and plan documents as needed.
- Resource: IRS announces 2026 employee benefit plan limits
HDHP Telehealth Safe Harbor
- What Changed? What to Know: The One Big Beautiful Bill restored pre-deductible telehealth relief for HDHPs effective for plan years beginning January 1, 2025.
- Employer Takeaway: Confirm that plan design and communications accurately describe telehealth coverage.
- Resource: IRS Notice 2026-5
ACA Affordability and Penalties
- What Changed? What to Know: The 2027 affordability percentage is 10.22%; employer-mandate penalties increase to $3,340 and $5,010.
- Employer Takeaway: Test the lowest-cost self-only option under the applicable affordability safe harbor.
- Resource: Penalties| Internal Revenue Service
ACA reporting process
- What Changed? What to Know: Form 1095-C may be furnished only on request if notice and timing requirements are satisfied; IRS response timelines and limitations periods changed.
- Employer Takeaway: Establish are quest, notice, and Letter 226-J response workflow.
- Resource: Information reporting by applicable large employers| Internal Revenue Service
CAA filings and Mental Health Parity Act
- What Changed? What to Know: Gag clause attestations remain due December 31; RxDC reporting remains due June 1; NQTL comparative analysis obligations still apply.
- Employer Takeaway: Calendar recurring obligations and confirm parity documentation is current.
- Resources:
- Gag Clause Prohibition Compliance Attestation | CMS
- DOL Identifies Three Mental Health Parity Enforcement Priorities for 2026
- Identifying Potential Mental Health Parity Problems
About Olivia ‘Liv’ Ash
Olivia “Liv” Ash, Esq., MS, an ERISA attorney, currently serves as AVP, Sr. Benefits Counsel for Patriot Growth Insurance Services, LLC. She holds degrees in Exercise Science, Education, & Law, with Indiana licenses in law & well-being education. Liv supports Patriot’s national suite of advisors regarding federal regulatory compliance as applied to welfare plans. Liv creates content, provides guidance to staff, presents webinars on welfare topics & often speaks at conferences, workshops, & seminars. Liv is a galleried artist; published researcher; & bestselling author in the field of emotional health.
About Eboni Onuoha, Esq.
As Benefits Compliance Counsel, Eboni partners with Patriot brokers and producers to help clients navigate the complex and ever-changing world of employee benefits law. Her practice focuses on advising clients on compliance with ERISA, HIPAA, ACA, and other laws impacting group health and welfare plans. Eboni believes that building trusted relationships and helping clients confidently navigate regulatory challenges are the most rewarding aspects of her work. In her free time, Eboni loves reading, traveling the world, and watching horror movies.
Disclaimer: Content presented is not, nor is it intended to be legal advice; it is for general education purposes. Please consult local legal & tax counsel for specific guidance regarding any one welfare benefits plan. Content is the sole property of Patriot Growth Insurance Services, LLC, and is not to be modified in any way or used for any other purpose. © 2026 Patriot Growth Insurance Services, LLC.