Benefits Insights

Santa is not the only person who should be making a list and checking it twice this December.  All sponsors of self-insured medical plans should also make sure that they double-check their year end to do lists.  Since the passage of the Affordable Care Act (ACA), keeping your health plan in compliance seems more and more difficult each year.  We know you are busy, so here is a quick list for you to use to ensure you check some important compliance items off your list this December so that you don’t end up on the naughty list. 

1. Update your HIPAA policies – Last April, Health & Human Services (HHS) issued new HIPAA privacy regulations that restrict when reproductive health information can be shared for purposes of health care oversight, judicial or administrative proceedings, law enforcement purposes or to coroners and medical examiners.  These regulations require that all covered entities, including all self-insured health plans, update their HIPAA policies by December 23^rd.   Also, the members of your workforce that have access to your plan’s protected health information (PHI) must also be trained on these new requirements by December 23^rd.  For more information on these new rules, see our prior post.
2. Prepare for the Mental Health Parity requirements – This past fall, new regulations were issued under Mental Health Parity outlining the requirements for the non-quantitative treatment limitations (“NQTL”) analysis that all self-insured health plans must complete.  This analysis is to ensure that any NQTL in your plan (e.g., pre-authorization requirements) that applies to mental health and substance abuse services are comparable and applied no more stringently than the same NQTL is applied to medical/surgical benefits.  While this requirement is several years old, the regulations expand the analysis expected to be done and are effective January 1, 2025.  Plan sponsors cannot perform this analysis without collecting significant data from their TPAs/ASOs.  Therefore, now is the time to start planning how you will tackle this analysis.  For more information on this requirement, see our prior post.
3. Submit your gag clause attestation – Last year was the first time plan sponsors had to attest that all of their service providers had removed gag clauses from their health care contracts.  However, we’re finding that some plan sponsors did not realize this was an annual attestation.  Even if nothing has changed, all self-insured plan sponsors must again make this attestation by December 31, 2024.  The attestation itself is not complicated and is done on CMS’s website.
4. Review your high-deductible health plan (“HDHP”) to ensure it meets the requirements for 2025 – As a result of COVID, the HDHP rules were relaxed to allow telehealth services to be provided without cost sharing prior to an individual meeting the deductible.  This relief expires on December 31^st.  If your HDHP is still allowing free telehealth services, you should amend it by year end to make the services subject to the deductible or your participants will not be able to contribute to their HSAs in 2025.  While you are checking for this issue, also ensure that your deductibles satisfy the minimum deductible requirements for 2025 ($1,650 single/$3,300 for family).  We have seen this issue pop up more this year than previous years, which is why we covered it in a prior post last summer.  
5. Ensure your premiums are affordable under the ACA – This item is one we hope that you thought of before open enrollment.  But if you haven’t checked to make sure your premiums are affordable yet for 2025, better now than once the year begins.  For 2025, a premium is considered affordable if it is not more than 9.02% of an employee’s household income.  For more information on the affordability safe harbors, see our prior post.

If you would like more information on any of the above or need assistance in complying with any of these items to keep yourself off the naughty list, please contact any member of the Bricker Graydon Employee Benefits Team.