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Civil Penalty Amounts Increased

Civil Penalty Amounts Increased

2.5 minute read

Effective November 15, 2021, the U.S. Department of Health and Human Services has increased the following key penalties affecting group health plans.

Penalty Types

Penalty Description

Penalty Amounts

Summary of Benefits and Coverage (SBC)

Failure to provide group health plan participants and beneficiaries with an SBC

Up to $1,190 per participant or beneficiary

Medicare Secondary Payer

Offering Medicare beneficiaries financial or other benefits as incentives not to enroll in or terminate enrollment in a group health plan that would otherwise be primary to Medicare

Up to $9,753

HIPAA privacy and security rules

Penalties for a covered entity or business associate violating HIPAA’s privacy and security rules will depend on the violation involved. Penalties are broken down into tiers that reflect increasing levels of knowledge about the violation.

Tier 1: Min $120, Max $60,226, annual cap $1,806,757

Tier 2: Min $1,205, Max $60,226, annual cap $1,806,757

Tier 3: Min $12,045, Max $60,226, annual cap $1,806,757

Tier 4: Min $60,226, Max and annual cap $1,806,757


Employers should become familiar with the new penalty amounts and review their benefit plan administration protocols to ensure full compliance. The penalty amounts are adjusted annually for inflation to maintain their deterrent effect.

Download the bulletin for more details.

Learn more about self-funding.

This blog is intended to be a compilation of information and resources pulled from federal, state, and local agencies. This is not intended to be legal advice. For up to the minute information and guidance on COVID-19, please follow the guidelines of the Centers for Disease Control and Prevention (CDC) and your local health organizations.

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.

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Valerie Ortiz

Valerie Ortiz

Over the past 20 years, Valerie Ortiz has worn many hats at National Insurance Services. She currently heads up NIS’ Marketing Team where she helps to create and execute employee benefit communications based upon our public sector clients’ needs. Valerie brings order to the chaos and has a zeal for detail and a talent for organization.