Read up on our third quarterly blog of 2024.
2025 Open Enrollment Checklist
To get ready for open enrollment, employers who sponsor group health plans should be aware of compliance changes affecting the design and administration of their health plans for plan years beginning on or after Jan. 1, 2025. These changes include limits that are adjusted for inflation each year, such as the Affordable Care Act’s (ACA) affordability percentage and cost-sharing limits for high deductible health plans (HDHPs). Employers should review their health plan’s design to confirm that it has been updated, as necessary, for these changes.
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Using HSAs, Health FSAs and HRs for Over-the-Counter Items
Health savings accounts (HSAs), health flexible spending accounts (FSAs) and health reimbursement arrangements (HRAs) may provide tax-free reimbursements of certain over-the-counter (OTC) items. OTC items are generally available to consumers without a prescription.
To be reimbursable, an OTC item must be for “medical care,” as defined under Code Section 213(d). Medical care expenses are amounts paid for the diagnosis, cure, mitigation, treatment or prevention of disease, or for the purpose of affecting a structure or function of the body.
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DOL Issues Gag Clause Attestation Resources for 2024
On May 24, 2024, the U.S. Department of Labor (DOL) issued various resources to assist health plans and health insurance issuers in annually submitting their attestation of compliance with the Consolidated Appropriations Act’s (CAA) gag clause prohibition. These resources can be used to submit the next gag clause attestation, which is due by Dec. 31, 2024
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New HIPAA Rule Will Require Updates to Privacy Notices
On April 26, 2024, the U.S. Department of Health and Human Services (HHS) issued a final rule that strengthens the HIPAA Privacy Rule by prohibiting the disclosure of protected health information (PHI) related to lawful reproductive health care in certain situations. The final rule requires covered entities, including health plans, to update their privacy notices to:
• Describe the new privacy rights for reproductive health care and provide examples of the new disclosure restrictions; and
• Explain that PHI disclosed pursuant to the Privacy Rule may be subject to redisclosure and is no longer protected.
In addition, covered entities that handle certain substance use disorder (SUD) patient records must update their privacy notices to describe new privacy protections for these records. The deadline for covered entities to update their privacy notices for these changes is Feb. 16, 2026
