Renewal Season, Compliance Checklist, and Reminders

July 2026 

Deanna Sizemore, Director, Benefits Compliance 

Renewal compliance is frequently treated as a checklist to survive rather than a process to leverage. Every year, an overlapping set of federal (and some state) compliance obligations are triggered at renewal that extend beyond negotiating premiums and plan design. Employers who treat renewal season purely as a procurement exercise often miss notice deadlines, filing windows, and documentation requirements that carry financial and fiduciary exposure. However, employers that build these deadlines into their renewal project plan—rather than reacting to them after the fact—reduce fiduciary and excise-tax exposure, strengthen their negotiating position with carriers and vendors, and give employees more accurate, timely information at the moment they need it most: when they are choosing their coverage for the year ahead. 

The compliance obligations differ depending on whether a plan is subject to the Employee Retirement Income Security Act (“ERISA”). Most private-sector employer plans are ERISA-covered and carry the full weight of ERISA’s reporting, disclosure, and fiduciary rules. Governmental and church plans are exempt from ERISA, but that exemption is narrower than many sponsors assume: the Affordable Care Act (“ACA”), Health Insurance Portability and Accountability Act (“HIPAA”), Mental Health Parity and Addiction Equity Act (“MHPAEA”), nondiscrimination rules, and Medicare-related requirements reach non-ERISA plans through the Public Health Service Act (“PHSA”) and the Internal Revenue Code, largely mirroring the ERISA-side rules. This checklist summarizes the high-level compliance requirements that converge at renewal and provides a phased, dated checklist that flags what applies to ERISA plans, non-ERISA plans, or both.

This checklist is organized by when each task typically occurs relative to a renewal date, using a calendar-year plan as the reference point. Each item is tagged: (All Plans) applies regardless of ERISA status; (ERISA) applies only to ERISA-covered, private-sector plans; and (Non-ERISA) flags a special consideration for governmental or church plan sponsors.

Questions about how these requirements apply to your specific plan design or entity type? Connect with your Baldwin Employee Benefits team.

Group health plan renewal compliance checklist and time line

Six months or more before renewal

Strategic planning

• Determine whether the wrap plan document/SPD needs updating for material design changes. (ERISA)
• Confirm Applicable Large Employer (“ALE”) status for next year
  • Begin gathering data for Forms 1094-C/1095-C. The timing of this task varies depending on a group’s plan year, adjust as needed to be ready for the January filing deadline. (All Plans)

Plan design, vendor and contract review

• Benchmark plan design against the current year ACA out-of-pocket maximum (“OOP”), and for high-deductible health plans (“HDHP”), the HSA-qualifying minimum deductible and maximum OOP. (All Plans)
  • Update maximum contributions for health savings account (“HAS”), health care flexible spending account (“FSA”), dependent care FSA (“DCAP”), and commuter benefit limits for current year in plan documents and payroll systems. (All Plans)
  • Review carrier, Third-Party Administrator (“TPA”), Pharmacy Benefit Manager (“PBM”), and behavioral health vendor contracts for gag-clause language prohibited under the Consolidated Appropriations Act (“CAA”), 2021. (All Plans)
  • Confirm wellness program incentive design complies with the Americans with Disability Act (“ADA”) and Genetic Information Nondiscrimination Act (“GINA”) limits and, if the program is a group health plan, is reflected in the SPD. (All Plans; SPD inclusion is ERISA)
• Document the fiduciary process used to select and monitor all vendors, including the vendor responsible for the Non-Quantitative Treatment Limitation (“NQTL”) comparative analysis. (ERISA)

90–60 days before renewal 

Documentation and testing 

• Review and approve the Summary of Benefits and Coverage (“SBC”) for the new plan year terms for eligible employees. (All Plans) 
• Schedule Section 125 cafeteria plan nondiscrimination testing, HSA comparability testing (if outside of the cafeteria plan), and self-funded plan IRC §105(h) nondiscrimination testing as applicable at the close of open enrollment. (ERISA for cafeteria plan testing; §105(h) applies to self-funded plans regardless of ERISA status) 
  • Redetermine Medicare Part D creditable coverage status for the new plan year, accounting for CMS’s revised simplified determination methodology. (All Plans) 
• Refresh COBRA election and rate notices for new plan year premiums. (ERISA) 
• Recalculate ACA affordability safe harbors using the upcoming plan year affordability percentage. (ERISA/ALE) 

Open enrollment window (Typically 30–45 days before the effective date)

Distribute the open enrollment packet to all eligible employees and Consolidated Omnibus Budget Reconciliation Act (“COBRA”) qualified beneficiaries. The packet should include:

• SBC
• Baldwin Annual Notice Packet
  • HIPAA Notice of Special Enrollment Rights
  • ACA Notice of Patient Protections
  • Newborns’ and Mothers’ Health Protection Act (“NMHPA”) notice
  • Women’s Health and Cancer Rights Act (“WHCRA”) notice
  • HIPAA Notice of Privacy Practices – Notice of Availability (self-funded plans)
  • Children’s Health Insurance Program Reauthorization Act (“CHIPRA”) notice
  • No Surprises Medical Billing notice
  • Medicare Part D creditable coverage / non-creditable coverage notice (as applicable)
  • Other notices, if applicable include:
    • Wellness program disclosure
    • ADA Notice regarding Wellness program
    • ACA Grandfathered Health Plan notice.
• ACA Section 1557 nondiscrimination and language-assistance taglines if the plan sponsor is subject to Section 1557 (as applicable)

At renewal/plan effective date – 60 days after the effective date

• Execute updated plan documents, update the ERISA Wrap Plan Document/SPD or Summary of Material Modifications (“SMM”), and insurance or ASO contracts effective as of the renewal date. (ERISA-only plans)
• Receipt of compensation disclosure notices from covered service providers (Broker/consultant, Pharmacy Benefit Managers, and Third-Party Administrators) per the CAA 2021 and CAA 2026.
• Confirm availability with insurer or finalize NQTL comparative analysis so they are ready for participant or regulator production within 30 days of request.
• Submit the Medicare Part D creditable/non-creditable coverage disclosure to CMS within 60 days of the new plan year’s start (March 1 for calendar-year plans).

60 days or more after the effective date

¹ Self-only limit applies as embedded individual limit for those enrolled in family coverage. Limits apply to in-network Essential Health Benefits. ACA OOPs also apply to HSA compatible HDHPs, which are subject to separate IRS rules requiring minimum deductibles and maximum OOP limits. The lower of the two OOP limits (the HDHP limit) will apply.

² Annual penalty amount reflects 12-month total, but penalties are assessed monthly.

³ HSA compatible HDHPs are subject to both the HDHP and ACA OOP limit, meaning the lower of the two limits applies (the HDHP limit).

⁴ You cannot embed an individual deductible into a family plan that is less than the required family deductible.