2025 Benefits Compliance Highlights and Recap

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Amber Posthauer: Good afternoon, everyone. Thank you for joining us today. We're going to get started in 60 seconds to allow for all registrants to get connected. We'll get started shortly.

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Amber Posthauer: Welcome, everyone, to the 2025 Benefits Compliance Highlights and Recap.

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Amber Posthauer: Thank you all so much for joining us.

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Amber Posthauer: The Benefits Compliance Team will be answering the questions you send through the Q&A today. We'll try our best to answer all of your questions, but if for whatever reason we're unable to get to your question today, please follow up with your advisor for further assistance.

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Amber Posthauer: Today's presentation is being recorded. We will be sharing the recording in the follow-up email and on the NFP website.

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Amber Posthauer: If there are any portions of this call that you missed, by Monday, you will receive an email with a link to the full recording. The PowerPoint slides used during this presentation will be shared in the same email.

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Amber Posthauer: At this time, I'll hand it over to the Benefits Compliance Team.

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Amber Posthauer: Kelly, the floor is yours.

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Kelly Eckman: Alright, thanks, Amber, and welcome, everyone, and thank you for joining us.

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Kelly Eckman: I know it's probably a busy time for many people, as we're in the midst of the holidays and sort of wrapping up the year end, so we appreciate everyone joining us for this recap of 2025, and then looking ahead to some hot topics and trends for 2026.

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Kelly Eckman: And so here is the view of our smiling faces. Instead of just getting two of us, you are going to get

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Kelly Eckman: Our entire, kind of what we call our core team, our benefits compliance team, so here are our smiling faces, and as you may have noticed, you get to see us on camera today instead of just our names, so putting those faces and voices together.

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Kelly Eckman: Now, before we get too far into this, we always like to have a reminder that the information we're covering today, this is general guidance purposes, so we're not giving legal advice or tax advice today.

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Kelly Eckman: If you do have questions of, you know, legal nature, you need to address those with your own legal counsel or tax advisor. And the information we're talking about today is current, as of today, and you'll find out a little later why some of this is changing, potentially, day by day.

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Kelly Eckman: So, what are we going to cover today? So again, we're going to start with those highlights. What are some of those topics in 2025 that are helpful to kind of revisit and keep on your radar? So, we're going to look at some of the various updates from legislation this summer.

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Kelly Eckman: What we affectionately call Oh Bubba, or the one beautiful bill… Big Beautiful Bill Act. I always miss one of those Bs.

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Kelly Eckman: We're gonna look at some state updates and reminders. I know this is a topic that is something that is top of mind for a lot of you. And then we're gonna look at some mental health parity updates.

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Kelly Eckman: And then we're gonna look at 2026, and so we're gonna look at some trends and hot topics to consider, so we're gonna look at, healthcare price transparency rules.

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Kelly Eckman: And then look at some predicted agency guidance and kind of what to think about from a political landscape in 2026. And then we will finish up with some year-end housekeeping reminders.

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Kelly Eckman: So we're going to get started here, and Sharon is going to kick us off with some, tax account updates from that recent legislation.

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Sharon Cohen: Thanks, Kelly. We're going to use all kinds of letters today, so I'm gonna talk about direct primary care service arrangements, or what are known as DPCSAs under the OBBBA.

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Sharon Cohen: So this law does two things. First of all, beginning January 1 in 2026, certain coverage under DPCSAs will no longer disqualify an individual from contributing to an HSA.

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Sharon Cohen: And the law also provides that certain DPCSA fees are qualified medical expenses for purposes of,

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Sharon Cohen: I'm sorry, for purposes of an HSA, and can be reimbursed on a tax-free basis under an HSA. This is a shift from the earlier IRS proposed regulations, which generally treated these types of arrangements as incompatible with HSA eligibility.

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Sharon Cohen: So Congress has basically stepped in, with a statutory definition to give clearer boundaries and to make these arrangements workable alongside of HSAs. So what exactly qualifies as a DPCSA?

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Sharon Cohen: Well, this is an arrangement where a person pays a fixed periodic fee, usually it's monthly, for primary care services only. These services are delivered by a licensed practitioner, like a physician or a nurse practitioner, and the law is very intentional about its scope, so it's routine outpatient care. It does not include services requiring

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Sharon Cohen: General anesthesia, most prescription drugs other than vaccines, or lab work that would fall outside of typical primary care setting.

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Sharon Cohen: And there's also a fee cap, so for an individual to maintain HSA eligibility, the fee can't exceed $150 of self-only coverage, or self-only, or $300 for a family, and there is annual indexing.

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Sharon Cohen: The IRS recently issued some guidance, and it clarified that this limit applies only for purposes of HSA eligibility. If the fee were to exceed the limit, the individual will not be eligible to make contributions to an HSA for that month.

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Sharon Cohen: But the HSA could reimburse the higher fee As a qualified medical expense.

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Sharon Cohen: I want to draw quickly a distinction between concierge medicine and DPC services, because they sometimes get lumped in together. So, concierge medication… medicine is typically… it typically charges a higher annual fee for enhanced access to care. By contrast, a DPCSA is narrowly defined

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Sharon Cohen: to, primary care services. And the fee is capped, and it's a fixed fee as the practitioner's only compensation for primary care services. A label alone is not determinative, so the arrangement has to actually meet the statutory requirements.

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Sharon Cohen: I like to think of these arrangements and these issues, really, as employer plan adjacent.

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Sharon Cohen: It mostly impacts individuals and their HSA eligibility, rather than the employer or the employer's HDHP. An employer is not responsible for monitoring whether an employee has a permissible or impermissible, DPCSA or RANT coverage, but the employer can help educate employees and help them understand

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Sharon Cohen: which things would disqualify them from contributing to an HSA, or which expenses might be reimbursable under an HSA. So the big picture is that Congress created a pathway for people to pair direct primary care with an HSA, but they kept the definition pretty tight to avoid opening the door to arrangements that look more like comprehensive.

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Sharon Cohen: coverage.

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Sharon Cohen: Alright, let's go to the next one here.

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Sharon Cohen: Yep. Individual coverage and HSA. So, starting January 1 of 26,

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Sharon Cohen: bronze and catastrophic individual plans, whether they're purchased on or off the exchange, will be treated as qualified high-deductible health plan coverage for purposes of an HSA. So this would apply, again, regardless of the plan's deductible or out-of-pocket max, it expands HSA eligibility to individuals.

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Sharon Cohen: employers can contribute to the HSA of employees enrolled in these plans. It's especially relevant for employers offering individual coverage, HRAs or ICRAs.

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Sharon Cohen: It broadens the pool of employees who can receive, employer contributions. One key nuance is that ICRAs, cannot reimburse,

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Sharon Cohen: can only reimburse premiums for off-exchange, individual coverage, but not for plans purpose

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Sharon Cohen: purchased on the exchange, and this rule did not change. Employer HSA contributions, including those made via salary reduction through a cafeteria plan, are going to be subject

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Sharon Cohen: to the non-discrimination rules of Section 125. If it's made outside of the cafeteria plan, it will be subject to the comparability rules.

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Sharon Cohen: And employers with ICRIS are gonna, if they want to implement this, should, speak to their vendors, are gonna wanna need… are gonna need to update their,

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Sharon Cohen: Plan documentation, talk to the payroll systems, employee communications to incorporate the new eligibility and contribution options.

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Sharon Cohen: All right, let's move on to our next things.

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Sharon Cohen: Sorry, that is, the permanent extension of telehealth for HSA Safe Harbors,

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Sharon Cohen: this was something that had been in place prior to the beginning of this year, and it sunset or expired, and the OBBBA, just re… re-included it back in here. So some employers had dropped that coverage, telehealth coverage for purposes of, HSA eligibility, whether or not it impacted it.

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Sharon Cohen: And others just kept the law in there, or kept the rule in there, because

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Sharon Cohen: The idea was that Congress was gonna

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Sharon Cohen: re-implemented. So Congress did, it took effect in January of this year. Some employers may have held off from implementing it, and if they're doing it for this coming year, they would need to speak with their carrier, the TPA, and implement, you know, the language in their plan documents, update, the SMM and all of that to re-include

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Sharon Cohen: it back in there.

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Sharon Cohen: So if we take another minute and step away from HSA coverage and we think about DCAPs, the law also increased the, maximum annual DCAP, or dependent care, plan exclusion.

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Sharon Cohen: This year, coming up on January 1st, the amount… the maximum amount that can be excluded under a DCAP is increasing from $5,000 to $7,500, and from $2,500, if you're married, filing separately, to $3,750.

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Sharon Cohen: This amount is not indexed, it's just a set amount.

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Sharon Cohen: employers are not required to adopt the higher compensate, you know, the maximum contribution. There may be some reasons why they won't want to do it. These plans tend to be what we call top-heavy, which is they get

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Sharon Cohen: a higher number of highly compensated individuals participating in them, and that could

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Sharon Cohen: be due to, a lag in reimbursement. So, for a lot of these fees related to dependent care, someone might have to pay for the service up front, like at the beginning of the month at a… for a daycare center, and they are not able to be reimbursed for that until the services have been provided, which is a DCAP rule. And so we tend to get a higher, paid person participating in the

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Sharon Cohen: plan. So, we recommend, if an employer implements the higher rate, to run non-discrimination tests early, to, put in, you know, a campaign to try to enhance the benefit for individuals that are lower paid to participate and increase that participation.

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Sharon Cohen: Let's go to our next slide.

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Sharon Cohen: So, we are still getting some questions, because there was some publicity about things that were in the bill, or going to be in the bill, and they may have been in this bill at one point, but they actually never

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Sharon Cohen: made it up into the final bill, and we just wanted to clarify, some of those issues here. So there have been no, increase in contribution limits to an HSA. Those things are annual, they're tied to your HDHP coverage. They index, as usual. There's been no increase in that.

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Sharon Cohen: The HSA and FSA enhanced rollover expansion did not come to fruition, so those carryover and grace period rules, they remain unchanged.

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Sharon Cohen: With regard to qualified medical expenses.

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Sharon Cohen: fitness costs and gym memberships and other sort of wellness expenses are generally not qualified medical expenses. Nothing has changed with regard to that. There can be instances where they are, prescribed to help with a specific disease or health condition, like if you've broken your leg and you need to do some rehab for that, or physical therapy.

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Sharon Cohen: They might be qualified medical expenses, but nothing has changed with regard to those. And there have been no changes in what or what isn't considered impermissible coverage with respect to a spouse having a health FSA

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Sharon Cohen: a general purpose health FSA that will still disqualify an individual from contributing to an HSA under their employer plan. Medicare Part A remains disqualifying coverage, and on-site clinics

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Sharon Cohen: We'll also be disqualifying coverage unless the coverage is limited to permitted care, like preventive care. And with that, let's head over to a state update.

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Kelly Eckman: Alright, thanks, Sharon. Yeah, we're gonna move into our state updates, and first…

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Kelly Eckman: Patrick is gonna take us through just some quick, state reporting reminders.

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Patrick Myers: Thank you, Kelly.

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Patrick Myers: As everyone may recall, the ACA, when it was enacted, has carried within it an individual mandate, which required individuals to obtain coverage or pay a penalty.

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Patrick Myers: However, starting in 2019, Congress had reduced the penalty for failing to meet the mandate to $0, effectively rendering the federal mandate, individual mandate, toothless.

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Patrick Myers: However, a handful of states have taken up that call and imposed their own individual mandates.

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Patrick Myers: requiring residents of those states to have coverage or pay a penalty. Those states include California.

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Patrick Myers: Massachusetts, New Jersey, Rhode Island, Vermont, and the District of Columbia.

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Patrick Myers: Employers are generally speaking, obligated to report to those states whether or not their resident employees have coverage.

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Patrick Myers: And the reporting, to do so, they can usually submit the federal forms, those 1094s, 1095s that they're already generating for the federal. At the federal level, they can submit those to those states as proof that their residents are indeed getting coverage.

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Patrick Myers: Now, something too important to point out here is that, as you may know, this year, in 2025,

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Patrick Myers: The federal government gave employers the choice of either, furnishing those 1095 forms to employees upon request, subject to some requirements.

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Patrick Myers: Or furnish those directly to them as usual.

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Patrick Myers: However, each state's individual mandate still generally requires employers to automatically distribute those coverage statements to employees.

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Patrick Myers: Regardless of any request to do otherwise, and to submit reports to state agencies by specific annual deadlines. So, the option to post those or furnish them on request don't trickle down to the states. At the state level, you'll still have to furnish those

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Patrick Myers: actual forms.

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Patrick Myers: To the residents of those states, as well as to the states themselves, in order to evidence that the resident employees, are actually getting those coverage, the coverage required under those states.

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Patrick Myers: So, if you have a fully insured plan, Typically.

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Patrick Myers: The carriers may be doing that for you, or on behalf of the employers, but it's always a good idea to check with the carriers to make sure they're actually doing that.

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Patrick Myers: And if you are a self-insured employer, then the employer itself is responsible for making those, or filing those forms and showing those… showing that their resident employees are meeting the mandate.

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Patrick Myers: And we have an excellent publication, the State Individual Mandate Report Requirement Publication, that goes into much more detail about these requirements, what needs to be done to fulfill them, and when those filing dates are.

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Patrick Myers: And so that wraps up our individual mandate reporting requirements section, so I'll pass it back over to Kelly.

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Patrick Myers: To talk about some more state requirements.

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Kelly Eckman: Alright, thanks, Patrick. Yeah, definitely, if you haven't taken a look at this publication, and you have employees in these states, definitely, request a copy of that from your consultant or advisor, because it has a lot of helpful information.

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Kelly Eckman: For those requirements. And so now, sticking in the state realm, we are going to take a look at some state PFML updates, and Molly's going to take us through that.

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Mollie Sledd: Hi, everyone!

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Mollie Sledd: All right, so it's always a good idea to take stock of where we are, with state paid family and medical leave laws and requirements, because that is a constantly changing, constantly evolving area. Seems like new states are being added.

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Mollie Sledd: colored into this map here every single year. So, here's the kind of snapshot of where we are right now. The states that are colored green have a paid family and medical leave requirement, so that means that, you know, employees can take it if they have

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Mollie Sledd: A serious health condition for themselves, or if they need to take care of a family member, for example, after a birth.

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Mollie Sledd: Hawaii, however, just has the disability piece, which means, you know, an employee's own serious health condition.

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Mollie Sledd: Vermont and New Hampshire, they have an asterisk here because

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Mollie Sledd: Those are… they're not required, for private employers to adopt them. They are optional programs that employers in those states… employees working in those states can opt into.

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Mollie Sledd: Okay.

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Mollie Sledd: So, looking ahead at 2026 and beyond, we do have some state programs that are rolling into place. So, if you have employees who are working in Delaware or Maine, hopefully you've already started

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Mollie Sledd: Paying into the system, whether you're doing payroll deductions for the state program, or you have an approved private plan that will provide that benefit.

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Mollie Sledd: Benefits are going to be starting January 1st. That means that employees can go ahead and apply with the state, or with your policy, for eligible leave in those two states.

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Mollie Sledd: Marilyn, poor Marilyn, they have a family program, a PFML program, that has been delayed and pushed back a few times now. It was supposed to go into effect starting in 2026, but now we're at…

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Mollie Sledd: Contributions starting January 1st, 2027, so you have another year there, with benefits starting January 3rd of 2028.

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Mollie Sledd: So that's where we are right now. Stay tuned on Maryland. Minnesota, in Minnesota, they are… I don't know if it's just that they're extremely nice, or…

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Mollie Sledd: very, very, excited about getting started with their PFML program, because they have both contributions and benefits starting January 1st, 2026. Usually you see a lag there between the two, but, in Minnesota, make sure you are ready to go.

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Mollie Sledd: All right? So, all of the states that we just looked at on the previous slide have now, updated their 2026 contribution benefit maximums

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Mollie Sledd: you know, notices, all their information for 2026 is… has been updated and put out there. And… and, you know, we definitely advise you to check with each and every state where you have employees working to make sure that you are aware of any and all changes.

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Mollie Sledd: You'll want to make sure you update your leave policy, work with your payroll vendor, or if you have a leave management vendor, if, you know, your disability carrier is handling it for you, make sure that they are aware of

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Mollie Sledd: The new figures that are in effect for 2026, as well as new notices or posters that have to go to employees who are working in those states.

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Mollie Sledd: So, generally, it's a good idea to have an action plan when it comes to state-mandated leave and, leave… your leave program in general, right? So you…

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Mollie Sledd: We do recommend that you establish a company leave policy that addresses all facets of employee leave, you know, whether that be the mandated state PFML program.

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Mollie Sledd: you know, the unpaid job protection under FMLA, an internal leave benefit policy that you may want to implement in addition to what is required under state or federal law.

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Mollie Sledd: you know, the STD and LTD program that you might have, etc. It's a good idea to really think about that holistically and try to make all of those pieces

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Mollie Sledd: Work together.

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Mollie Sledd: Alright, also remember that some state PFML programs provide job protection and employee benefit continuation. For example, New York and Colorado do.

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Mollie Sledd: Other states do not, though. All they provide is the income replacement without the job protection piece. That would… usually, that comes from another state law that is, like, the state FMLA version, kind of.

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Mollie Sledd: Alright, so if you are an employer with employees in multiple states, especially the states that were on that, you know, on that map that we just looked at on the last page, then, you know, we realize that you are…

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Mollie Sledd: Facing a lot of challenges when it comes to making sure that you are complying with all the pieces.

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Mollie Sledd: So, we definitely think that you should, again, take a look at your policy as a whole, work with your disability vendors and your payroll, and consider maybe even, you know, if things are getting really complicated, using a leave vendor to help you out with all those requirements.

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Mollie Sledd: Alright.

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Mollie Sledd: And then, we have a publication. It's a quick reference chart. It's kind of a short, simple piece that lays out all those states.

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Mollie Sledd: with the basics of what their PFML program, requires and involves, and that is hot off the presses as of yesterday morning.

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Mollie Sledd: With all those new 2026 numbers.

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Mollie Sledd: So, please, make sure you reach out to your NFP account team to get a copy of that publication.

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Mollie Sledd: Thank you very much.

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Kelly Eckman: Alright, thanks, Molly. Yeah, the state… I know we've covered the state items in, you know, webinars previously. Even this year, touched on bits and pieces of it recently, but it's definitely a topic that we get asked questions about all the time, and it's always one of the

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Kelly Eckman: ones that people are still saying that, you know, you want more information in webinars, so hopefully you find that useful, and you've taken a look or requested that,

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Kelly Eckman: publication, because it really is, a great resource. And so now we're going to leave, state updates, and we are going to go to, some mental health parity updates, and Sarah's going to take us through that.

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Sarah Burns: Thanks, Kelly. Yeah.

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Sarah Burns: We're going to talk about MAPEA specifically, the non-quantitative treatment limitation comparative analysis. Not easy to say, not easy to complete.

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Sarah Burns: And it's been a recurring topic for us for the past few years, because it's been an enforcement priority, it's complicated, it requires a lot of cooperation with carriers and TPAs.

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Sarah Burns: Some of which have been reluctant to step up, so it continues… it's a requirement that continues to put us and all of our clients in a tough spot. We could spend all day talking about Mapia, but obviously we've got loads of other topics to cover this hour, so we're going to just go quickly through

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Sarah Burns: Some of the 2025 developments, and then point to, our resources for more information.

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Sarah Burns: So, quick recap, the Consolidated Appropriations Act of 2021, the CAA of 2021, as we call it, it introduced this new, NQTL comparative analysis requirement. So, an NQTL, that's the acronym for Non-Quantitative Treatment Limitation.

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Sarah Burns: Things like coverage exclusions, prior authorizations, medical necessity guidelines, network restrictions, really any coverage limitations that can't be quantified and easily compared.

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Sarah Burns: And plans and insurers need to actually document NQTL compliance through what's called, a comparative analysis. That's what the comparative analysis is.

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Sarah Burns: And that has been in effect since February 2021. Basically, the comparative analysis, I like to think about it, first you have to identify each mental health and QTL, and then justify its inclusion in the plan.

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Sarah Burns: Justified by showing that it's somehow comparable to and not applied more stringently than similar medical coverage terms.

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Sarah Burns: So…

00:26:28.330 --> 00:26:47.779

Sarah Burns: There's no requirement to annually submit the comparative analysis, but plans, employers, sponsoring plans, and insurers need to have it on hand to be able to quickly reply to any requests from a federal or state agency, or a participant or plan beneficiary, which we think would be more likely.

00:26:47.980 --> 00:27:00.600

Sarah Burns: So, in 2024, we've got… we had final rules, and we talked about these last year. Those final rules from 2024. Added a few new requirements. The first was the meaningful benefits requirement.

00:27:00.600 --> 00:27:09.080

Sarah Burns: And that requirement was that the plan needs to provide a full range of treatments for mental health conditions. The rules refer to these as core treatments.

00:27:09.170 --> 00:27:20.800

Sarah Burns: The final rules from 2024 also require plans to look at outcomes data to address differences in access to mental health benefits, again, as compared to medical benefits.

00:27:21.070 --> 00:27:36.200

Sarah Burns: So those two requirements really relate to the details of the analysis. I think more relevant to employers that aren't actually completing the analysis, which is fewer actually completing, most have their GPAs do it, or, perhaps a vendor do it.

00:27:36.420 --> 00:27:43.079

Sarah Burns: But for all employers, the final rules added, or all-risk employers, the final rules added a fiduciary certification.

00:27:43.080 --> 00:27:56.290

Sarah Burns: requiring a plan fiduciary to sign off on the analysis. So, that really felt more like a formality, I think, regardless of any specific certification requirement, ERISA plan sponsors

00:27:56.290 --> 00:28:04.140

Sarah Burns: There's still fiduciaries responsible for making sure that the analysis is completed, and that overall the plan, is in compliance.

00:28:04.410 --> 00:28:21.399

Sarah Burns: Okay, let's move to this year. So, in January, the ERISA Industry Committee, so the acronym they go by is ERIC. Eric advocates on behalf of large employers. They filed a lawsuit challenging those 2024 final rules.

00:28:21.400 --> 00:28:29.149

Sarah Burns: as going beyond the tri-agency's authority. Tri-agencies being DOL, HHS, and IRS.

00:28:29.680 --> 00:28:39.330

Sarah Burns: Eric took particular issue with two parts of the final rules. The first is that meaningful benefits requirement that I just mentioned, right? The requirement to include core treatments.

00:28:39.450 --> 00:28:43.129

Sarah Burns: And then the second was the requirement to look at outcomes data.

00:28:43.490 --> 00:28:44.440

Sarah Burns: So…

00:28:44.600 --> 00:29:00.510

Sarah Burns: Eric's argument, one of their arguments, was basically that the Mapia statute doesn't mandate any particular benefits, it only requires parity in plan terms and application, not parity in outcomes. So that's how they were challenging those two requirements.

00:29:00.630 --> 00:29:03.899

Sarah Burns: The meaningful benefits and the outcomes, data requirement.

00:29:04.440 --> 00:29:16.499

Sarah Burns: They also claimed that the final rules were… are so confusing, so unworkable, so burdensome, that they would lead some employers to not offering mental health benefits at all. Because remember,

00:29:16.540 --> 00:29:32.749

Sarah Burns: offering MAPIA, excuse me, offering mental health benefits in the first place is not mandated under MAPIA, it's only that if an employer… if an insurance plan offers mental health benefits, the coverage terms need to be comparable to, meaning at least as good as medical benefits.

00:29:33.280 --> 00:29:41.049

Sarah Burns: Along with the litigation, Eric sent a request directly to those tri-agencies requesting that the implementation be put on hold.

00:29:41.080 --> 00:29:42.920

Sarah Burns: And on May 15th.

00:29:42.940 --> 00:29:53.919

Sarah Burns: The agencies did just that. They put enforcement of those September final rules on hold while the lawsuit is pending, and then for an additional 18 months. So, a long time.

00:29:53.920 --> 00:30:04.979

Sarah Burns: In putting those rules on hold, they noted that they're still considering whether to pull back or modify the rules, because they are concerned with the burden that it places on employers.

00:30:05.400 --> 00:30:16.989

Sarah Burns: However, they were very clear that enforcement on the underlying requirement, right, that comparative analysis that went into effect in 2021, it is still in effect.

00:30:17.090 --> 00:30:28.810

Sarah Burns: And I checked the docket for this lawsuit earlier today. There's nothing new to report. The last was a status report from the government saying they're still considering whether to pull back or modify the 2024 rules.

00:30:29.050 --> 00:30:30.920

Sarah Burns: Kelly, can you go to the next slide?

00:30:32.330 --> 00:30:34.390

Sarah Burns: So, looking ahead,

00:30:34.550 --> 00:30:39.319

Sarah Burns: Even if these rules are ultimately withdrawn by the agencies, or they're struck down by the court.

00:30:39.360 --> 00:30:57.979

Sarah Burns: The comparative analysis is rooted in the CIA 2021, and it would take so rooted statute, so it would take an act of Congress to actually amend that statute, and we've seen bipartisan support for access to mental health treatment, historically, so we don't, at least at this point, see that that's going to happen.

00:30:58.020 --> 00:31:07.420

Sarah Burns: But we do expect that there are, and there will continue to be, fewer resources for DOL investigations, and…

00:31:07.730 --> 00:31:11.740

Sarah Burns: possibly Mapia investigation specifically.

00:31:12.150 --> 00:31:27.019

Sarah Burns: But there is the continued risk of participant litigation. That hasn't changed, and so often the participant litigation includes penalty claims for failing to provide a comparative analysis within 30 days, along with other plan documents.

00:31:27.590 --> 00:31:47.240

Sarah Burns: So, can't just ignore the comparative analysis requirement. The general steps towards compliance haven't changed with the pause on the final rules, and really with one exception, I guess that would be the fiduciary certification I mentioned, but that's really not a new substantive requirement, it's more of a formality.

00:31:47.810 --> 00:31:50.110

Sarah Burns: So, for next steps,

00:31:50.220 --> 00:32:01.600

Sarah Burns: MAPIA compliance is going to continue to be a real challenge. This year, we released an updated employer guide on the NQTL comparative analysis, pictured right there, to help

00:32:01.600 --> 00:32:12.750

Sarah Burns: It's got, employer action items based on whether you're fully insured or self-insured, tools for working with your TPAs, guidance on selecting a testing vendor if needed.

00:32:12.750 --> 00:32:30.849

Sarah Burns: guidance on assessing risk, including certain red flags, and that's that second, publication image right there. It's really important to be attuned to red flags and see whether they need to be removed from a plan, and by red flags, I mean things like, exclusions for ABA therapy for autism.

00:32:30.850 --> 00:32:38.829

Sarah Burns: certain restrictions on out-of-network benefits just for mental health, but there's a full list in there for you to review.

00:32:38.930 --> 00:32:53.950

Sarah Burns: And, you know, we always like to say that employers should pay attention to participant complaints, because they signal trouble, they often signal trouble. The DOL isn't picking plans at random to investigate, they're driven, they're triggered by these complaints.

00:32:54.150 --> 00:33:08.359

Sarah Burns: they also signal a risk of a lawsuit, right? Not only a deal investigation, but a participant lawsuit's gonna start with a claim denial, and often, a complaint to the employers behind that. So…

00:33:08.390 --> 00:33:14.809

Sarah Burns: Those are our resources. Please ask, you know, your NFP broker or consultant for a copy of these.

00:33:15.600 --> 00:33:17.210

Sarah Burns: That's an Amapia, Kelly.

00:33:17.210 --> 00:33:26.929

Kelly Eckman: Awesome, thanks, Sarah. Yeah, definitely a topic to watch, seems to be every year, we're kind of keeping an eye on it, so it'll be interesting to see what 2026 brings us for.

00:33:26.930 --> 00:33:27.320

Sarah Burns: For sure.

00:33:28.380 --> 00:33:43.199

Kelly Eckman: And so now we're gonna switch gears, and we're going to kind of look at, you know, we've covered what happened and some of those hot items in 2025, so now we're gonna look ahead for some things to kind of keep on your radar as we head into this next calendar year.

00:33:44.140 --> 00:33:52.859

Kelly Eckman: And so, first, Carol's gonna lead us off into some, healthcare price transparency rules and what to look for in this coming year.

00:33:54.760 --> 00:34:13.440

Carol Wood: Thanks so much, Kelly. And yeah, we're gonna… we're gonna take a step back, and good afternoon, everybody. Take a step back, and then we're going to move forward. Healthcare price transparency and the related rules we know, has been a hot topic in recent years. We expect it to continue to be. And

00:34:13.699 --> 00:34:25.439

Carol Wood: And just maybe we should define it first, what we're talking about with healthcare price transparency is this concept of ensuring that consumers, which include plant sponsors.

00:34:25.449 --> 00:34:34.219

Carol Wood: Have accurate, complete, and meaningful data, so they can make informed decisions about healthcare benefits.

00:34:34.400 --> 00:34:45.750

Carol Wood: And armed with this information, they should be able to negotiate better prices for their plans. This, in turn, creates a more competitive market.

00:34:45.960 --> 00:34:55.300

Carol Wood: And overall, will lower lower prices, lower healthcare prices. So that's really the idea behind it.

00:34:55.360 --> 00:35:12.640

Carol Wood: Of course, and related to this is that the data is so critical to our plan sponsors, because they, as fiduciaries, have an obligation to make sure that they're prudently using their plan assets and selecting and monitoring their service providers.

00:35:13.280 --> 00:35:20.660

Carol Wood: So, why is there such a heightened focus on healthcare price transparency? I think the obvious reason is that

00:35:20.810 --> 00:35:31.960

Carol Wood: the healthcare, healthcare prices, and particularly prescription drug prices, they've continued to rise. We haven't seen a lowering of the prices yet, so, you know.

00:35:31.990 --> 00:35:44.229

Carol Wood: Pharmacy benefits have been a particular focus, our weight loss drugs, the GLP-1s, of course, they're used for other purposes as well, but also cancer treatment drugs, and

00:35:44.380 --> 00:35:55.079

Carol Wood: While the drug market is complex, it's certainly believed that a lack of transparency, opaque contracts, are a contributing factor to these prices.

00:35:56.140 --> 00:36:11.279

Carol Wood: You know, fortunately, the Trump administration does view healthcare price transparency and lowering drug prices as priorities, which is interesting, right? They're largely deregulatory, but they've zeroed in on healthcare price transparency. They've issued

00:36:11.280 --> 00:36:17.129

Carol Wood: the administration's issued two executive orders this year. The first issued in March.

00:36:17.430 --> 00:36:26.860

Carol Wood: and we'll use the short name, Making America Healthy Again, called for action to improve and enforce existing price transparency laws.

00:36:26.940 --> 00:36:29.160

Carol Wood: And for group health plans.

00:36:29.200 --> 00:36:38.450

Carol Wood: Specifically, the order asked the agencies to issue guidance to fully implement and enforce the transparency and coverage rule.

00:36:38.450 --> 00:36:49.799

Carol Wood: Now, you, as plan sponsors, are all familiar with this. This brought us the requirement to post machine-readable files for our in-network rates and out-of-network allowed amounts.

00:36:49.880 --> 00:37:02.469

Carol Wood: But what you may have forgotten is there was also a requirement to post prescription drug prices. That was never actually implemented, due to litigation. So…

00:37:02.520 --> 00:37:21.530

Carol Wood: We believe the guidance that the agencies are going to issue will focus largely on that, and also on just more accuracy in the data that's already being posted. And this data is very important. I should share with you. It's not useful directly to employers.

00:37:21.530 --> 00:37:28.070

Carol Wood: But the data analytics folks have been able to take the MRF data, and

00:37:28.210 --> 00:37:42.739

Carol Wood: incorporated into useful tools for plan sponsors to, compare prices. Much more useful than our RXDC reporting data and all, to getting, you know, to, to helping plan sponsors, so…

00:37:42.740 --> 00:37:48.659

Carol Wood: That's the first order. The second one, was aimed at lowering drug prices.

00:37:48.710 --> 00:38:03.180

Carol Wood: by increasing competition in drug markets, you know, the order itself was broad. It called for, you know, looking into increasing imports of drugs, to streamlining the drug approval process, but for group health plan sponsors.

00:38:03.230 --> 00:38:16.690

Carol Wood: It asked the DOL to propose rules, to help sponsors understand the compensation received by their pharmacy benefit managers, to… to propose rules that the

00:38:17.270 --> 00:38:33.389

Carol Wood: We know that employers as plan sponsors have an obligation to receive and review disclosures from their group health plan service providers regarding their compensation that was part of the Consolidated Appropriations Act of 2021.

00:38:33.390 --> 00:38:41.799

Carol Wood: These are known as 40B2 disclosures, so we're going to be seeing guidance there in response to the order.

00:38:42.730 --> 00:38:45.320

Carol Wood: The focus is also,

00:38:45.490 --> 00:38:54.530

Carol Wood: On health care price transparency, is also due to class action litigation against group health plan sponsors.

00:38:54.860 --> 00:39:03.650

Carol Wood: The most famous case is the Johnson & Johnson case, that was the first. There are others, the Wells Fargo case, and

00:39:03.840 --> 00:39:11.620

Carol Wood: In this litigation, the participants are alleging that the group health plan sponsor

00:39:11.710 --> 00:39:28.700

Carol Wood: has failed to negotiate competitive pricing for their plans, and with their service providers, they're essentially paying too much in fees, particularly for pharmacy benefits. Now, thus far.

00:39:28.760 --> 00:39:41.769

Carol Wood: all of the claims in these cases have been dismissed. That's good for plan sponsors, because the participants really couldn't, draw a link between the high prices.

00:39:41.900 --> 00:39:56.449

Carol Wood: and their premiums and cost shareings, they were, you know, they couldn't draw a link that they were really harmed, by the employer's actions, but, still something to monitor. And we've also seen a lot of state PBM

00:39:56.730 --> 00:40:13.350

Carol Wood: legislative activity, and this is looking to regulate the activities of pharmacy benefit managers and their practices for their residents. In some states, Arkansas, more recently California, they've been pretty aggressive with that.

00:40:13.570 --> 00:40:14.680

Carol Wood: Next slide.

00:40:17.890 --> 00:40:19.559

Carol Wood: So what will happen next?

00:40:19.780 --> 00:40:30.079

Carol Wood: Well, employers should expect, this is very important, significant healthcare price transparency rules to be proposed and released in the coming days.

00:40:30.130 --> 00:40:43.689

Carol Wood: And this is in response to the Trump executive orders, and these will impact your group health plans and your compliance obligations. And we really see this as imminent, so this could be within the next week.

00:40:43.900 --> 00:40:59.159

Carol Wood: maybe not the holiday surprise that you're looking for, but you should be aware of this. The agency guidance will likely address the transparency and coverage rule that prescription drug MRF posting requirement, and perhaps a timeline for implementation.

00:40:59.270 --> 00:41:05.440

Carol Wood: And the rules will also address the PBM compensation disclosures

00:41:05.540 --> 00:41:17.229

Carol Wood: And hopefully also provide broader guidance to health plan fiduciaries regarding how exactly they should be prudently selecting and monitoring service providers.

00:41:17.240 --> 00:41:29.510

Carol Wood: Yeah, we're hoping that it's… this legislation is really going to be helpful for plan sponsors, and give us that guidance so they know what to do to fulfill their obligations.

00:41:29.810 --> 00:41:46.640

Carol Wood: Unfortunately, we expect the litigation against plan sponsors will likely continue. It's something to monitor. Class action lawyers will probably come up with new legal theories, but… but there is some good news in that

00:41:46.700 --> 00:42:03.740

Carol Wood: the new DOL secretary, he's pushed to end ERISA litigation abuse, these meritless claims against plan sponsors, and the Trump administration seems to be supporting that, so I think that's a positive development.

00:42:03.870 --> 00:42:12.129

Carol Wood: On the state PBM fronts, we, expect that activity will continue unless

00:42:12.260 --> 00:42:23.279

Carol Wood: And until we see federal PBM legislation enacted, there is some federal PBM legislation, in the works now.

00:42:23.280 --> 00:42:38.570

Carol Wood: Including the PBM Price Transparency and Accountability Act. So that's pending in Congress, and it seeks to limit certain PBM pricing and contracting policies that impact group health plans, but we'll have to see if that makes it to the finish line.

00:42:39.180 --> 00:42:40.240

Carol Wood: Next slide.

00:42:41.320 --> 00:42:53.320

Carol Wood: So what should an employer plan sponsor do now? Well, certainly, when this new guidance is released, review it, and begin preparing to implement it once it's finalized.

00:42:53.320 --> 00:43:01.259

Carol Wood: This means employers will need to consult with their service providers, including their PBMs, to ensure they'll assist the employer

00:43:01.260 --> 00:43:13.840

Carol Wood: in implementing the requirements, the prescription drug MRF posting, and you should also be looking at your contract terms, too. Make sure, you want to make sure they're agreeing to fulfill those obligations in the contract.

00:43:13.970 --> 00:43:24.330

Carol Wood: And employers should also be ensuring that their fiduciary governance practices are in order, particularly with respect to selecting and monitoring service providers and their compensation.

00:43:24.520 --> 00:43:33.569

Carol Wood: Employers should continue to monitor any ERISA fiduciary breach litigation and federal PBM legislative activity.

00:43:33.750 --> 00:43:44.170

Carol Wood: And finally, I would expect a lot of activity in the prescription drug space in the coming year. We don't know how some of the new developments, we heard of TrumpRx.

00:43:44.170 --> 00:43:55.010

Carol Wood: There's also manufactured direct-to-consumer, and now, even more recently, direct-to-employer marketing, for certain drugs, but, you know, whether they'll be,

00:43:55.040 --> 00:44:08.930

Carol Wood: those options will be available to sponsors in an effective and compliant manner, we don't know. But we do hope and expect that these initiatives overall will create a more health… competitive healthcare

00:44:08.930 --> 00:44:17.139

Carol Wood: And prescription drug marketplace, and that will in turn lower prices. So, there's a lot to watch here. I just threw out a lot of information at you, but

00:44:17.150 --> 00:44:29.550

Carol Wood: Please stay tuned. And we do have publications, our transparency publication, and also ERISA Fiduciary governance publication to assist you, with fulfilling your obligations.

00:44:30.710 --> 00:44:36.619

Kelly Eckman: Great, thanks, Carol. Yeah, prescription drug and transparency in general, those are definitely going to be topics

00:44:36.690 --> 00:44:51.789

Kelly Eckman: to look for it and kind of keep your ears open for 2026. And now I'm going to take us through just some general kind of, you know, potential agency guidance that we're looking to see in 2026, and just some additional hot topics.

00:44:52.020 --> 00:44:55.200

Kelly Eckman: That employers and plan sponsors want to consider.

00:44:55.210 --> 00:45:11.799

Kelly Eckman: So, this first one here, I think, is something that many of you have heard about. So, this is the expiration of the enhanced premium tax credit, so the subsidies. This was obviously a large player in the government shutdown, so we want to kind of give an update.

00:45:11.800 --> 00:45:18.140

Kelly Eckman: of where this stands. And so, for those that aren't familiar, you know, what are those enhanced premium tax credits?

00:45:18.210 --> 00:45:36.890

Kelly Eckman: So, originally, when we had, you know, the premium tax credits, or think of it as the subsidies on the marketplace, those were for people with incomes, of 100% to 400% of the federal poverty level. So those were the original subsidy kind of income requirements.

00:45:37.030 --> 00:45:51.810

Kelly Eckman: Then, back in 2021, with ARPA, that maximum was eliminated. So, even folks who had incomes above 400%, they could qualify for some level of…

00:45:51.810 --> 00:46:03.599

Kelly Eckman: premium tax credit as well. So that was the enhanced part of it. Those rules are set to expire at the end of this year, unless we have an extension.

00:46:03.810 --> 00:46:23.089

Kelly Eckman: So again, what's been happening? As I said, it was a big player in the government shutdown. One of the compromises that were made to lead to the end of the shutdown is congressional leaders did agree to hold a vote on whether or not these enhanced

00:46:23.210 --> 00:46:34.160

Kelly Eckman: premium tax credits would be extended past 12, 1231. So, where do we stand? So, last week, the Senate held a vote.

00:46:34.260 --> 00:46:45.619

Kelly Eckman: It did not pass. And then, this week is when we were looking to see the House vote on it. We had some late-night developments, or end-of-the-day developments.

00:46:45.620 --> 00:46:57.640

Kelly Eckman: from the House, where basically the House is using, what we're calling a procedural move to force a floor vote. However, that floor vote is not going to happen until January.

00:46:57.700 --> 00:47:13.839

Kelly Eckman: So, the House essentially is not gonna vote on it for quite some time. We thought they might vote this week. That obviously is not happening. So where we stand today is Congress is still negotiating, right? So…

00:47:14.040 --> 00:47:28.690

Kelly Eckman: whether or not this extension will happen is still up in the air, although I think many agree that it's probably unlikely we'll see an extension, but we don't know, right? We won't know until we know.

00:47:28.900 --> 00:47:36.530

Kelly Eckman: So as it stands today, the credits are set to expire at the end of this year.

00:47:36.860 --> 00:47:55.300

Kelly Eckman: Again, barring any sort of unexpected development between now and potentially a vote in January. So, this definitely can impact, you know, those who were maybe still hoping or expecting to receive those enhanced, premium tax credits for their marketplace coverage.

00:47:55.380 --> 00:47:58.310

Kelly Eckman: I've got an important note here at the bottom.

00:47:58.610 --> 00:48:16.739

Kelly Eckman: You know, if someone is losing a subsidy, or they were… or the prices are changing, they were expecting to have that tax credit, and now they're not going to have it in 2026. That does not create a mid-year election change event, or sometimes called a qualifying life event.

00:48:16.770 --> 00:48:21.859

Kelly Eckman: For an employer… or for an employee to join the employer plan mid-year.

00:48:22.260 --> 00:48:40.850

Kelly Eckman: And this is kind of a common situation that gets confused. We actually included this as our frequently asked question in our Compliance Corner newsletter that just came out today, so definitely take a look at that. We'll go into more detail. But I just wanted to pull that up because I think this is a topic

00:48:40.940 --> 00:48:47.710

Kelly Eckman: That a lot of people are asking about if they have employees who are going to be losing those subsidies.

00:48:49.320 --> 00:48:51.750

Kelly Eckman: And then the next topic here,

00:48:51.830 --> 00:49:07.940

Kelly Eckman: with the DOL electronic disclosure rules. So, I think many are aware that, in certain circumstances, employers can distribute, you know, annual notices or other required plan documents electronically instead of having to deal with

00:49:07.970 --> 00:49:12.660

Kelly Eckman: Hard copies, or, you know, mailing those to employees.

00:49:12.660 --> 00:49:30.569

Kelly Eckman: So the current rules, as they stand, basically say that the only way an employee can receive electronic notices is if they have work-related computer access as an integral part of their job, or if they consent to receive these notices electronically.

00:49:30.990 --> 00:49:41.599

Kelly Eckman: The DOL, fortunately, is looking to modernize this process, and it would be similar, to some changes we saw in 2020 in the retirement plan world.

00:49:41.620 --> 00:49:57.800

Kelly Eckman: So basically, it's sort of recognizing, right, society has changed. People are glued to their phones, most people are going to have email addresses and internet access, and so accessing documents electronically is much easier than years before.

00:49:57.930 --> 00:50:13.370

Kelly Eckman: employers, if you are one that still prints and mails documents, you know that can be very costly. So a change in these rules would really help employers save money. So, we don't know what this will look like yet, but the hope would be that it would

00:50:13.500 --> 00:50:27.310

Kelly Eckman: create a default to electronic disclosures. So, first step would be to receive those electronically, and then an employee could opt out of receiving those electronic notices or documents and get paper instead.

00:50:27.350 --> 00:50:44.260

Kelly Eckman: So I think that would be a welcome change to employers and plan sponsors. We'll just have to wait and see what that looks like. Right now, we're seeing, the target date for proposed regulations would be May of 2026, so we'll kind of keep our eyes open for what that may look like.

00:50:45.570 --> 00:51:01.079

Kelly Eckman: And then, a couple miscellaneous updates, fertility benefits. So, one of the campaign promises from the Trump administration, and then a February executive order, was increasing access to IVF.

00:51:01.120 --> 00:51:19.610

Kelly Eckman: And so, in October, the, we did get some guidance, basically giving some options for employers on, you know, potentially ways to increase that access. So, one option is, offering standalone, fully insured fertility coverage to all employees.

00:51:19.610 --> 00:51:29.770

Kelly Eckman: And even those who are not enrolled in the employer's group health plan, as long as it meets certain criteria, to make it be considered what we call an accepted benefit.

00:51:29.770 --> 00:51:31.470

Kelly Eckman: The key here is…

00:51:31.560 --> 00:51:43.800

Kelly Eckman: you know, the policy needs to be issued as a separate policy as it stands, so that's why, a self-insured plan for this fertility coverage would not be allowed currently. Again.

00:51:43.960 --> 00:51:58.769

Kelly Eckman: always going to be subject to change. Another option presented in the guidance for fertility expenses is an EBHRA, or an Accepted Benefit HRA. Again, it's another way to potentially reimburse fertility expenses.

00:51:58.770 --> 00:52:06.249

Kelly Eckman: In that case, it would only be for employees who are also offered the group health plan, so a little difference in eligibility.

00:52:06.400 --> 00:52:14.669

Kelly Eckman: Opening access to common fertility drugs, potentially available on TrumpRx,

00:52:14.880 --> 00:52:24.859

Kelly Eckman: you know, we'll see what that looks like, or what actually becomes available, but that is something that we may see in 2026 as well. So again, the theme of increasing access.

00:52:25.260 --> 00:52:42.080

Kelly Eckman: And then finally, federal paid leave initiatives. You know, Molly walked us through the patchwork of state laws here, and it can definitely be confusing for, employers that have employees in many different states. So this is just kind of some potential working groups.

00:52:42.110 --> 00:53:00.350

Kelly Eckman: to work through ways to more streamline the rules state by state, or to potentially even offer grants to states that are kind of working to make this easier for employers. It does not require states to offer this coverage, it's just trying to make it…

00:53:00.560 --> 00:53:09.999

Kelly Eckman: more efficient. So we'll kind of wait and see what this looks like in 2026 as well, but again, definitely a hot topic to keep a lookout for.

00:53:10.900 --> 00:53:16.570

Kelly Eckman: And now we're gonna close out with some year-end reminders and benefits housekeeping with Ben.

00:53:17.680 --> 00:53:35.410

Benjamin Merry: Hey, thanks, Kelly, and good afternoon, everyone. I'm sure a lot of activity in Washington going on, so lots to look forward to in the new year. But before we wrap up, let's take a quick look at some of those outstanding compliance tasks that you might need to address soon, if you haven't already.

00:53:35.700 --> 00:53:46.269

Benjamin Merry: Nfp has a guide on each of the requirements that I'm about to mention, so, again, please ask your NFP consultant for a copy if you'd like more information about anything I'm about to discuss.

00:53:46.560 --> 00:53:52.609

Benjamin Merry: Up first is the attestation for your group health plan's compliance with the gag clause prohibitions.

00:53:52.670 --> 00:54:06.350

Benjamin Merry: This is the third year that plans are required to attest, so hopefully this isn't a new requirement to anyone joining us today, but if it is, group health plans are prohibited from agreeing to contracts that include what are called gag clauses.

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Benjamin Merry: So these are terms that restrict the plan from sharing certain cost and quality data with their members or with referring providers.

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Benjamin Merry: There are also terms that restrict the plan from accessing certain claims data.

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Benjamin Merry: If your health plan is fully insured, check with your carrier to make sure that your carrier will attest on behalf of the plan.

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Benjamin Merry: If you're self-insured, you should have a conversation with your TPA or your other service providers, like your PBM, to understand if they'll attest on behalf of your plan.

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Benjamin Merry: Ultimately, if your plan is self-insured, which includes level funded, it's up to you as the employer to attest. So if your TPA doesn't attest, or if they'll only attest to

00:54:46.360 --> 00:54:54.570

Benjamin Merry: parts of your plan, but not all of it, then it's ultimately gonna be up to you to attest or to fill in the gaps on your TPA's attestation.

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Benjamin Merry: Those attestations are due by, December 31st. We've included the link on the screen here to CMS's website, where you can go ahead and complete those.

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Benjamin Merry: Aca Form W-2 reporting is also coming up. Employers must file their W-2s with the Social Security Administration every year by January 31st.

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Benjamin Merry: If you filed 250 or more Forms W-2 last year, you're required to report the aggregate cost of employer-sponsored group health coverage on each covered employee's W-2 this year.

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Benjamin Merry: So that includes the total value of employer and employee contributions together, for coverage.

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Benjamin Merry: The cost of coverage is reported on box 12 of an employee's W-2, using code DD.

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Benjamin Merry: So again, check with your payroll vendor, to determine if they're handling this requirement. If you're doing payroll or W-2 reporting in-house, just make sure you know whether you're subject to this requirement so you can prepare accordingly.

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Benjamin Merry: Next up is imputed income.

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Benjamin Merry: This is something that needs to be on your radar if your business offers group-term life insurance to employees, or if your employees can elect any health benefits for their domestic partners.

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Benjamin Merry: Through group term life insurance, any coverage over $50,000 is taxable to the employee.

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Benjamin Merry: You may also need to tax, the full value of coverage if you're, for any key employees, if your plan is found to be discriminatory, if it doesn't pass those, those group term life insurance non-discrimination tests.

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Benjamin Merry: And then health coverage for a domestic partner is also taxable, unless a domestic partner qualifies as an employee's tax dependent, which is pretty rare.

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Benjamin Merry: So the way to make sure employees are taxed appropriately on this coverage is by imputing income.

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Benjamin Merry: Basically, the employer adds the cash value of a taxable benefit to an employee's gross income, then withholds taxes based on that additional income.

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Benjamin Merry: If you've been imputing income throughout the year and withholding those taxes on the value of this coverage all through the year, then you're probably good. If you haven't been doing that.

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Benjamin Merry: Then you'll need to impute income for employees, and then reconcile those taxes at the end of the year so they can be reported accurately on Forms W-2.

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Benjamin Merry: So again, as with the W-2 reporting, check with your payroll vendor and determine if you still need to impute income before the end of the year.

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Benjamin Merry: If you do, it's probably a good idea to communicate to your employees what you're doing, so that they're not caught by surprise if they get a smaller paycheck than they're expecting, because more taxes come out at the end of the year.

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Benjamin Merry: Nfp did publish a calculator earlier this year to help employers to determine the fair market value of domestic partner coverage.

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Benjamin Merry: So, you know, I invite you to ask your NFP consultant to show you that calculator, and show you how it works if you're looking for a little additional help on imputing income.

00:57:52.580 --> 00:58:00.000

Benjamin Merry: And then, last on our year-end to-do list is to double-check your health plan's HIPAA Notice of Privacy Practices to make sure that it's up to date.

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Benjamin Merry: Updates are due by February 16th.

00:58:03.570 --> 00:58:09.579

Benjamin Merry: And we've kind of seen the HIPAA privacy requirements whipsaw back and forth in the last few years.

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Benjamin Merry: There was a substance use disorder rule that the Biden administration issued in 2024. There was also a reproductive healthcare privacy rule.

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Benjamin Merry: The healthcare privacy, or the reproductive healthcare privacy rule, is no longer being enforced. It's been set aside, so you don't need to update your privacy practices for that, but the substance use disorder rule, it was primarily targeted at treatment facilities that receive federal funding.

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Benjamin Merry: However, it does require all covered entities, so group health plans, to update their notices of privacy practices, just to include certain, information about their use and of, substance use disorder treatment records.

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Benjamin Merry: So, check with your HIPAA vendor to make sure that your plan's notice is compliant. You still have until February 16th, so there's still plenty of time to get that up to date if you need to.

00:59:02.320 --> 00:59:19.720

Benjamin Merry: And then, as we reach the end of our presentation here, just want to remind you that HSA annual limits are increasing for 2026. Sharon also mentioned that the Dependent Care Assistance Program, those annual limits, also increase as of January 1.

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Benjamin Merry: Employers don't have to adopt those new limits, and, you know, if you, if you have historically had trouble passing the non-discrimination test, you may want to keep your limits as is for 2026.

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Benjamin Merry: There we have it. We're at, we're at 3 o'clock Central. Kelly, I'll pass it back to you.

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Kelly Eckman: Alright, thanks, Ben. Yeah, so, since we're at the top of the hour, thank you everyone for joining us. I know we covered a lot. As always, take a look at those slides in the recording once it is sent out, and let your consultants know if you have questions, and otherwise,

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Kelly Eckman: We hope you all have a great holiday season, and thank you so much for joining us, and I'll pass it back to Amber.

00:59:59.780 --> 01:00:06.510

Amber Posthauer: All right. Well, thank you to our NFP benefits compliance team for sharing your valuable time and expertise with us today.

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Amber Posthauer: To reiterate, today's presentation has been recorded. We'll be sharing the recording in the follow-up email and on the NFP website. If there are any portions of this call that you missed, by Monday you'll receive an email with a link to the full recording. The PowerPoint slides used during this presentation will be shared in the same email. At the end of this call, a survey will populate in a new window.

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Amber Posthauer: Please take a brief moment to complete the survey, as it lets us know what topics are important to our listeners, and helps make our education program as current and relevant as possible. That concludes our webinar for today. Thank you, everyone, for joining us, and have a great day!