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Employers should note key compliance issues affecting 2025 health plans. These include new ACA reporting requirements, anticipated health care transparency rules, and potential shifts in policy due to political changes. Key issues to watch: new mental health parity rules, the end of telemedicine exceptions for high deductible health plans (HDHPs), and possible increased oversight of pharmacy benefit managers to manage costs.
Simplified ACA Reporting
At the end of 2024, Congress passed two laws, the Paperwork Burden Reduction Act and the Employer Reporting Improvement Act, simplifying ACA reporting for employers and limiting IRS penalty assessments. Key changes include: individual health coverage statements are now only required upon request, electronic consent for statements is allowed, and birth dates can replace taxpayer identification numbers. Additionally, applicable large employers now have 90 days to respond to IRS penalty warnings, with a six-year limit on IRS collections.
Expiration of Telemedicine Exception for HDHPs/HSAs
Telemedicine surged during the COVID-19 pandemic and remains a key healthcare option. Employers with HDHPs linked to Health Savings Accounts (HSAs) should note that telemedicine benefits can affect HSA eligibility. For 2025, the minimum HDHP deductible is $1,650 for individuals and $3,300 for families. Previously, a relief measure allowed telehealth benefits before meeting deductibles, but this expired on December 31, 2024. Without an extension, HDHPs must impose deductibles on telehealth services starting January 1, 2025, to maintain HSA eligibility. Communicate any changes to telemedicine coverage to plan participants promptly.
New Fiduciary Certification Requirement Under MHPAEA
In September 2024, a final rule was introduced to enhance MHPAEA compliance, ensuring mental health and substance use disorder (MH/SD) benefits are not more restricted than medical/surgical (M/S) coverage. The focus is on NQTLs, which are nonnumerical limits like prior authorization. Health plans must conduct and share comparative analyses of NQTLs for MH/SUD versus M/S benefits. ERISA plans need a fiduciary certification for these analyses. Compliance starts in 2025, with some requirements delayed to 2026. Employers should coordinate with issuers or third-part administrators to meet these standards.
Reproductive Health Privacy
A new final rule enhances HIPAA privacy by restricting the disclosure of protected health information (PHI) related to reproductive health care. Effective December 23, 2024, stricter guidelines prevent using or disclosing PHI for investigations or identifying individuals in connection with reproductive health care. Regulated entities must obtain valid attestations for certain disclosures. Employers with health plans should update HIPAA policies and train staff on these changes. The U.S. Department of Health and Human Services offers a model attestation form, and health plans must update their privacy notices by February 16, 2026.
Health Plan Transparency Reminders
In recent years, new transparency requirements for employer-sponsored health plans and insurers have been introduced to enhance healthcare quality and reduce costs by increasing information accessibility. As we approach 2025, employers should ensure compliance with these requirements, which include:
- Self-service price comparison tools for real-time cost estimates of covered items and services.
- Publicly accessible machine-readable files (MRFs) with updated pricing details.
- Notices on surprise medical billing protections.
Additionally, health plans must report prescription drug and healthcare spending annually and confirm that agreements with providers do not include prohibited gag clauses. Employers should verify that their service providers meet these transparency standards and consider requesting compliance reports.
Other Potential Developments
Upcoming compliance changes in 2025 could affect health plan coverage. Key developments may include: updates to the HIPAA Security rule for better cybersecurity, new oversight of PBMs to manage healthcare costs, state mandates for fertility treatment coverage, ongoing litigation on various health plan issues, and new transparency requirements like advanced EOBs. Stay informed to ensure compliance and optimize your health plans. Download the bulletin for more details.
National Insurance Services is not a law firm and no opinion, suggestion, or recommendation of the firm or its employees shall constitute legal advice. Readers are advised to consult with their own attorney for a determination of their legal rights, responsibilities and liabilities, including the interpretation of any statute or regulation, or its application to the readers’ business activities.
