Employers must comply with numerous reporting and disclosure requirements in connection with their group health plans. Please note the following upcoming deadlines:
| DUE DATE | TOPIC | REQUIREMENT |
|---|---|---|
| 12/16/2024 | Health Insurance Responsibility Disclosure (“HIRD”) form due to Massachusetts Department of Revenue: For more information visit this link | Applies to employers (regardless of location) with six or more employees within Massachusetts during the previous 12 months Filing is to be completed electronically from 11/15/2024-12/16/2024 |
| 12/16/2024 (or 2 months after close of extension period for filing Form 5500) | Summary Annual Report, if extension was filed (calendar year plans) | Plan Sponsors that file Forms 5500 must provide to covered participants |
| 12/23/2024 | HIPAA Policies | Review and update HIPAA policies and procedures regarding the use and disclosure of protected reproductive health information and provide training, where appropriate, to their workforce members |
| 12/31/2024 | Update/amend documents for 2024 plan year | Provide updated SBCs in connection with plan’s 2025 open enrollment period Amend cafeteria plan to reflect any changes made in 2024 Amend/restate wrap document and SPD as necessary |
| 12/31/2024 | Nondiscrimination Testing | Ensure applicable nondiscrimination testing is performed at least annually Code Section 105(h) for self-funded health plans, including Health Care FSAs and HRAs Code Section 79 for Group Term Life Insurance Code Section 125 for Cafeteria Plans Code Section 129 for Dependent Care FSAs Code Section 127 for Educational Assistance Code Section 137 for Adoption Assistance |
| 12/31/2024 | Attestation of compliance with prohibition on gag clauses | Ensure any contracts with third party administrators (“TPAs”) or other health plan service providers offering access to a network of providers do not violate the CAA’s prohibition of gag clauses: Fully insured plan sponsors: confirm insurer will provide attestation Self-insured plans: consider entering into written agreements with their TPAs to provide the attestation, but the legal responsibility ultimately remains with the health plan |
| 1/1/2025 | IRS benefit limits for 2025 take effect | Ensure benefit and payroll systems are properly updated to reflect adjusted limits Confirm plan’s out-of-pocket limit for essential health benefits doesn’t exceed ACA limits for plan year beginning in 2025 ($9,200/$18,400) FSA maximum contribution limit for 2025 plan year is $3,300 ($660 carryover limit) Excepted Benefit HRA maximum for 2025 plan years is $2,150 |
| 1/1/2025 | HIPAA Policies and Procedures | Policies and procedures should be updated to reflect the enhanced privacy considerations associated with reproductive rights. Employers must also begin utilization of their plan’s individually adopted consent for authorization of release of certain reproductive information |
| 1/1/2025 | First-dollar preventive care coverage (applies to non-grandfathered plans) | Confirm health plan covers the latest recommended preventive care services without cost sharing (see https://www.healthcare.gov/coverage/preventive-care-benefits) for latest recommended services |
| 1/1/2025 | San Francisco Health Care Security Ordinance (SFHCSO) changes for 2025: Health care expenditure rates increase to $3.85/hour (businesses with > 100 employees) and $2.56/hour (businesses with 20-99 employees) Updated notice for posting at workplace Revocable health care expenditures no longer permitted | Employers subject to the SFHCSO must comply by making required health care expenditure payments on behalf of covered employees (generally those employed >90 days and working at least 8 hours per week in the City) |
| 1/1/2025 | Employer Mandate (“play or pay”) | Confirm applicable large employer (ALE) status for 2024 ALEs have at least 50 full-time employee equivalents in prior year (2024) Determine full-time employee status for 2025 using lookback measurement method or monthly measurement period, as applicable Confirm compliance with guidance on cash-out arrangements and wellness incentives Determine affordability (9.02% of household income) using W-2, rate of pay, or federal poverty level safe harbor) and minimum value thresholds (60%) for 2025 4980H(a) monthly penalty amount = $2,900/12 x Full-time employees (less first 30) 4980H (b) monthly penalty amount =$4,350/12 x FT employees receiving a subsidy Confirm plan documents/ SPDs and employee handbooks have been updated to reflect any changes made to eligibility criteria |
| 1/1/2025 | Grandfathered Health Plans (“GF”) | Confirm plan’s status for 2025: If plan lost status, confirm that plan has adopted all additional patient rights and benefits required by non-GF plans If plan-maintained GF status, continue to provide Notice of Grandfathered Status in plan materials provided to participants |
| 1/1/2025 | Compliance effective date for Phase III of Final Transparency in Coverage Rules requiring the hosting of an internet-based price comparison tool to be made available to participants, beneficiaries and enrollees for all covered items and services | Fully insured plans—Employers should confirm that their issuer will comply with the price comparison tool requirements beginning with 2024 plan years and ensure this compliance responsibility is reflected in a written agreement Self-insured plans—Employers should reach out to their TPAs (or other service providers) to confirm they will be in compliance by the deadline and update agreements to reflect this responsibility. In addition, employers should monitor their TPAs’ compliance with this requirement. Unlike fully insured plans, the legal responsibility for this tool stays with a self-insured plan even if its TPA agrees to provide the price comparison tool on its behalf |
| 1/1/2025 | Employers with 10 or more filings in the aggregate are required to file certain information returns with the IRS electronically, including those required to comply with the employer shared responsibility provisions under the Affordable Care Act | Employers who are not currently set up for electronic filing should take steps to do so soon, whether on their own or through a third-party. Reporting entities in a position to perform their own electronic reporting can review the IRS’ ACA Information Returns (AIR) Program webpage Read here for more information on the electronic filing process and the AIR System, as well as IRS Publications 5164 and 5165 |
| 1/31/2025 | W-2 Reporting of Employer Sponsored Benefits (Transitional relief for employers with less than 250 W-2s until further guidance) | Employers that filed 250 or more IRS Forms W- 2 for the prior calendar year must include the aggregate cost of employer- sponsored health plan coverage on employees’ Forms W-2. Include the aggregate cost of medical insurance (generally not dental, vision, disability benefits or FSA unless employer contributions made) Employers must file Forms W-2 with the Social Security Administration and furnish Forms W-2 to employees Work with payroll vendor to ensure compliance |
| 1/31/2025 | Massachusetts Form 1099-HC due to employees who are state residents to assist them in filing their tax returns; report listing of all Form 1099- HCs issued due to State. For further information visit https://www.mass.gov/service- details/health- care-reform-for-employers | Responsibility of health insurer and/or employer (if self-funded) Confirm that the health plan meets the definition of creditable coverage under Massachusetts state law requirements Work with health insurer to confirm party responsibility for providing Form and ensure timely distribution |
| 1/31/2025 | IRS Forms 1095-C due to employees of self-insured medical plans to comply with CA Individual Mandate | Self-insured plan sponsors comply by providing Form 1095-C statements to all covered employees (and non-employees), regardless of FT status, including completing Part III of the Form 1095-C |
To see the full 2024 year of Compliance Deadlines, click on this LINK.
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