Employers must comply with numerous reporting and disclosure requirements in connection with their group health plans. Please note the following upcoming deadlines:
2025 Calendar Year Plan Requirements
|
DUE DATE |
TOPIC |
REQUIREMENT |
|
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 years 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/cover age/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 2025 § ALEs average at least 50 full- time employees in prior year (2024) § Determine full-time employee status for 2025 using lookback measurement |
|
DUE DATE |
TOPIC |
REQUIREMENT |
|
1/1/2025 |
Employer Mandate (“play or pay”) (Continued) |
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 |
Employers with 10 or more Information 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 |
|
DUE DATE |
TOPIC |
REQUIREMENT |
|
1/31/2025 |
W-2 Reporting of Employer Sponsored Benefits (Transitional relief for employers with less than 250 W-2s until further guidance) (Continued) |
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 State website. |
§ 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 |
|
3/1/2025 |
Form M-1- Annual Reporting |
§ Applies to administrators of multiple employer welfare associations (MEWA) and entities claiming exemptions from certain federal law requirements § File online at www.askebsa.dol.gov/mewa |
|
3/2/2025 (or 60 days after beginning of plan year being reported to CMS) |
For calendar year plans, Medicare Part D disclosure to CMS regarding creditable coverage status of a group health plan’s prescription drug coverage |
§ Complete online disclosure form available at https://www.cms.gov/Medicare/Pre scription-Drug- Coverage/CreditableCoverage/CCDi |
|
3/3/2025 |
Disclosure Statements to Employees under Internal Revenue Code Sections 6055 and 6056
Employers should review state requirements as they may still need to automatically provide a 1095-C to their employees based on state requirements. |
§ Upon request of the employee, ALEs must provide a copy of Form 1095-C to their full- time (FT) employee within 30 days tocomply with the Paperwork Reduction Act of 2024 § Self-funded employers must also provide, , upon request, Form 1095-C statements to all covered employees (and non- employees), regardless of FT status |
|
DUE DATE |
TOPIC |
REQUIREMENT |
|
3/3/2024 |
Disclosure Statements to Employees under Internal Revenue Code Sections 6055 and 6056 (Continued) |
Section 6055’s requirements for the 2024 calendar year, including completing Part III of the Form 1095-C § Statements can also be used to satisfy some state individual mandate disclosure requirements |
|
3/31/2025 (if filing electronically) |
IRS Reporting Under Code Sections 6055 and 6056 |
§ Applicable large employers (ALEs) must file completed Forms 1094-C and 1095-C with IRS to comply with Code Section 6056 § To comply with Code Section 6055, carriers (fully insured plans) and employers that are not ALEs who sponsor self-insured health plans use Forms 1094-B and 1095-B to meet this reporting obligation |
|
3/31/2025 |
Rhode Island individual mandate reporting due to Division of Taxation. For further information, visit State website |
§ Employers (or TPA) of self-funded plans will file Forms 1095-C (Form 1094-B if self- insured sponsor is not an applicable large employer) § Insurance carriers will file Forms 1095-B on behalf of sponsors of fully insured plans |
|
3/31/25 |
Reporting due to CA Franchise Tax Board to satisfy the California Mandate. For further information, visit State website |
§ Employers with self-funded plans must file Form 1095-C with state electronically or by mail (electronic filing required if 250 for more Forms 1095-Cs) § Insurance carriers will file Form 1095-Bs on behalf of fully insured plan sponsors |
|
3/31/25 |
Reporting due to State of New Jersey to satisfy state’s shared responsibility requirement For more information, visit State website |
§ Employers of self-funded plans will file Forms 1095-C, NJ-1095, or Form 1095-B (if self- insured sponsor is not an applicable large employer) § Note: If using Form 1095- C, Parts I, II, and III all must be completed § Insurance carriers will file Forms 1095-B on behalf of sponsors of fully insured plans § Electronic filing only; paper filing will not be accepted |
|
3/31/25 |
Reporting due to State of New Jersey to satisfy state’s shared responsibility requirement. (Continued) |
§ Insurance carriers will file Forms 1095-B on behalf of sponsors of fully insured plans § Electronic filing only; paper filing will not be accepted |
|
DUE DATE |
TOPIC |
REQUIREMENT |
|
4/30/2025 |
District of Columbia Individual Mandate Reporting. For further information, visit District website |
§ Applies to employers with at least one employee residing in Washington D.C. § Same information as filed with the IRS § Must be filed within 30 days of IRS deadline for filing |
|
4/30/2025 |
Annual San Francisco Health Care Security Ordinance (SFHCSO) Reporting |
§ Employers subject to the SFHCSO must file annual report for the 2024 calendar year with the Office of Labor Standards Enforcement |
|
6/2/2025 |
Prescription Drug and Health Care Spending Reporting |
§ Annual report due to the federal government by employer- sponsored health plans and health insurance issuers to report information about prescription drugs and health care spending to the federal government for the 2024 reference year. This reporting process is referred to as the “prescription drug data collection” (“RxDC report”) |
|
6/2/2025 |
Prescription Drug and Health Care Spending Reporting (Continued) |
§ Most employers will rely on third parties, such as issuers, third-party administrators (TPAs) or pharmacy benefit managers (PBMs) to prepare and submit the RxDC report for their health plans |
|
7/29/2025 |
Summary of material modifications (SMMs)
Due 210 days after end of plan year |
§ Distribute SMMs regarding plan amendments adopted during previous year (2024 that reflect changes to the Summary Plan Description (SPD) (unless revised SPD is distributed that contains the modifications) |
|
7/31/2025 |
Calendar year Form 5500 reporting deadline
Last day ofthe 7th month after end of plan year |
§ All healthand welfare plans with 100+ participants that are subject to ERISA are required to report unless an exemption applies § Small health plans (fewer than 100 participants) that are fully insured, unfunded or a combination of insured/unfunded are generally exempt from the Form 5500 filing requirement. § Employers may request a one-time extension of 2 ½ months by filing a Form 5558 |
|
DUE DATE |
TOPIC |
REQUIREMENT |
|
7/31/2025 |
Patient Centered Outcomes Research Institute (PCORI) Fee due for plan years ending in 2024 |
§ Self-funded group health plans (including retiree plans and HRAs) must pay fee, based on enrollee count, using IRS Form 720 § For plan years ending after 1/1/24 and before 10/1/24 fee is $3.22 per enrollee § For plan years ending on or after 10/1/24 and on or before 12/31/24 (includes most calendar year plans), For plans ending in 2025, the fee is $3.47. § If medical plan is not self-funded or level funded, the medical carrier will be responsible for paying this fee directly to the IRS |
|
8/1/25 through 10/31/2025 |
Medical Loss Ratio (MLR) Rebates |
§ Sponsors of insured health plans may receive rebates if their issuers did not meet their MLR for the respective reporting year. Rebates must be provided to plan sponsors by September 30 following the end of the MLR reporting year. § Employers that receive rebates should considertheir legal options for using the rebate. Any rebate amount that qualifies as a plan asset under ERISA must be used for the exclusive benefit of the plan’s participants and beneficiaries. If received, the rebate amount attributable to plan assets generally must be distributed pro- rata to the members in either premium credits or other benefit within 90 days of receipt Plan sponsorsshould document how rebate was used |
|
9/30/2025 |
Summary Annual Report
9 months after end of plan year; additional 2 months permitted if Form 5558 extension filed) |
§ Plan Sponsors that file Form 5500 must provide to covered participants a summary of the information in the Form 5500. |
|
10/14/2025 |
Notice of Medicare Part D Creditable/ Non-Creditable Coverage (Medicare Part D Notice) |
§ Provide to Medicare Part D-eligible participants (employee or dependent who is over age 65 or permanently disabled) annually § Providing Notice during open enrollment to all participants is generally adequate. § Model disclosure notices are available on CMS’ website. |
|
DUE DATE |
TOPIC |
REQUIREMENT |
|
10/15/2025 |
Form 5500, if extension Form 5558 was filed (calendar year plans) 9 ½ months after end of the plan year+ extension period |
§ All health and welfare plans with 100+ participants that are subject to ERISA are required to report unless an exemption applies § Small health plans (fewer than 100 participants) that are fully insured, unfunded or a combination of insured/unfunded are generally exempt from the Form 5500 filing requirement. |
|
12/15/2025 |
Health Insurance Responsibility Disclosure (HIRD) form due to Massachusetts Department of Revenue For more information visit State website |
§ 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 11/15/2025- 12/15/2025 |
|
12/15/2025 |
Summary Annual Report, if extension was filed (calendar year plans) |
§ Plan Sponsors that file Form 5500 must provide to covered participants |
|
12/23/2025 |
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 |
|
12/31/2025 |
Update/amend documents for 2025 plan year |
§ Provide updated SBCs in connection with plan’s 2026 open enrollment period § Amend cafeteria plan to reflect any changes made in 2025 |
|
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 |
|
DUE DATE |
TOPIC |
REQUIREMENT |
|
12/31/2025 |
Submit a Gag Clause Attestation for health plan |
§ Amend/restate wrap document and SPD as necessary § Ensure any contracts with 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 |
To see the full 2025 year of Compliance Deadlines, click on this link.
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.
