On May 4, 2026, the IRS announced updated penalty amounts for 2027 under the Affordable Care Act’s (ACA) employer shared responsibility, or “pay-or-play,” rules. For the 2027 calendar year, the $2,000 penalty has been adjusted to $3,780, and the $3,000 penalty has increased to $5,670. This marks a rise from 2026 levels of $3,340 and … Continued
The Centers for Medicare and Medicaid Services (CMS) has released a final rule that exempts account-based plans, such as health reimbursement arrangements (HRAs) and health flexible spending accounts (FSAs), from Medicare Part D disclosure requirements. The change applies to coverage beginning Jan. 1, 2027. As background, employers with group health plans that provide prescription drug … Continued
As the calendar year progresses, employers that sponsor group health plans should take steps to stay ahead of key midyear compliance obligations. Federal reporting and disclosure requirements under laws such as the Employee Retirement Income Security Act (ERISA), the Consolidated Omnibus Budget Reconciliation Act (COBRA), and the No Surprises Act must be addressed during the … Continued
If your company provides an employee benefit plan governed by the Employee Retirement Income Security Act (ERISA), you are likely obligated to file Form 5500. This annual report discloses key details about your organization’s benefit offerings, such as welfare benefit plans (including medical, dental, life, and disability coverage), retirement plans, fully insured plans, and self-funded … Continued
On January 29, 2026, the U.S. Department of Health and Human Services (HHS) officially released the maximum cost-sharing limits for the 2027 plan year. These figures represent a significant 13.2% increase over the 2026 limits, marking a substantial shift in potential out-of-pocket expenses for plan participants. 2027 Maximum Out-of-Pocket Limits For 2027, the maximum annual … Continued
The Internal Revenue Service (IRS) has issued Notice 2025-61, announcing a significant increase to the Patient-Centered Outcomes Research Institute (PCORI) fee amount. Employers with self-insured health plans and health insurance issuers must take note of the new rate and upcoming compliance deadlines. What is the New PCORI Fee Amount? The PCORI fee is increasing to … Continued
The U.S. Department of Health and Human Services (HHS) has issued a final rule that requires covered entities—including many health plans—to update their Notice of Privacy Practices (Privacy Notice). This change enhances privacy protections for highly sensitive Substance Use Disorder (SUD) treatment records. Why the Update is Necessary The HIPAA Privacy Rule already mandates that … Continued
Employers with insured health plans may have received a Medical Loss Ratio (MLR) rebate from their health insurance carrier this year. Rebates were required for plans not meeting the 2024 MLR standards and had to be issued by September 30, 2025, either as premium credits or lump-sum payments. If any part of the rebate qualifies … Continued
The HIPAA Privacy Rule generally requires covered entities—such as health plans, health care providers, and health care clearinghouses—to give individuals a Notice of Privacy Practices (Privacy Notice). This notice explains how their protected health information (PHI) may be used or shared and outlines their rights related to PHI. In April 2024, the U.S. Department of Health and … Continued
Open enrollment is a hectic and critical period for employers that often brings a risk of compliance errors. These mistakes can confuse employees and cause missed benefits, while also exposing employers to legal risks. This article highlights five common compliance pitfalls to avoid during open enrollment: Ineffective Communication of Benefit Changes – Benefit offerings often change … Continued
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