March 2026
Diana Craig, Director, Benefits Compliance
On January 28, 2026, the U.S. Department of Health and Human Services (“HHS”) released annual penalty increases for several provisions affecting group health plans. These increased amounts apply to penalties assessed on or after January 28, 2026. Updated penalties for HIPAA violations, Medicare Secondary Payer violations and Summary of Benefits and Coverage failures are:
HIPAA
Indexed penalty amounts for each violation of a HIPAA administrative simplification provision are:
- Tier 1—Lack of Knowledge
- The minimum penalty is $145 (up from $141); the maximum penalty is $73,011 (up from $71,162); and the calendar-year cap is $2,190,294 (up from $2,134,831).
- Tier 2—Reasonable Cause and Not Willful Neglect
- The minimum penalty is $1,461 (up from $1,424); the maximum penalty is $73,011 (up from $71,162); and the calendar-year cap is $2,190,294 (up from $2,134,831).
- Tier 3—Willful Neglect, Corrected Within 30 Days
- The minimum penalty is $14,602 (up from $14,232); the maximum penalty is $73,011 (up from $71,162); and the calendar-year cap is $2,190,294 (up from $2,134,831).
- Tier 4—Willful Neglect, Not Corrected Within 30 Days.
- The minimum penalty is $73,011 (up from $71,162); the maximum penalty is $2,190,294 (up from $2,134,831); and the calendar-year cap is $2,190,294 (up from $2,134,831).
Medicare Secondary Payer
Indexed amounts for violations by employer-sponsored health plans are:
- Offering incentives to Medicare-eligible individuals not to enroll in a plan that would otherwise be primary: $11,823 (up from $11,524).
- Failure of responsible reporting entities to provide information identifying situations where the group health plan is primary: $1,512 (up from $1,474).
Summary of Benefits and Coverage (SBC)
The penalty for a health insurer’s or non-federal governmental health plan’s willful failure to provide an SBC is $1,443 (up from $1,406) per failure.
Additional Information and Resources
For more information
We’re ready when you are. Get in touch and a friendly, knowledgeable Baldwin advisor is prepared to discuss your business or individual needs, ask a few questions to get the full picture, and make a plan to follow up.
This document is intended for general information purposes only and should not be construed as advice or opinions on any specific facts or circumstances. The content of this document is made available on an “as is” basis, without warranty of any kind. The Baldwin Insurance Group Holdings, LLC (“The Baldwin Group”), its affiliates, and subsidiaries do not guarantee that this information is, or can be relied on for, compliance with any law or regulation, assurance against preventable losses, or freedom from legal liability. This publication is not intended to be legal, underwriting, or any other type of professional advice. The Baldwin Group does not guarantee any particular outcome and makes no commitment to update any information herein or remove any items that are no longer accurate or complete. Furthermore, The Baldwin Group does not assume any liability to any person or organization for loss or damage caused by or resulting from any reliance placed on that content. Persons requiring advice should always consult an independent adviser.
The Baldwin Group offers insurance services through one or more of its insurance licensed entities. Each of the entities may be known by one or more of the logos displayed; all insurance commerce is only conducted through The Baldwin Group insurance licensed entities. This material is not an offer to sell insurance.
