Preparing for 2026 Open Enrollment: A Compliance Checklist for Employers

As we look ahead to the 2026 open enrollment season, employers must brace for updated compliance requirements that affect group health plans starting January 1, 2026. Navigating these changes can be overwhelming—but being proactive can save your organization time, money, and compliance headaches.

Whether you’re an HR professional or benefits administrator, this checklist will guide you through everything you need to review, update, and communicate ahead of open enrollment.

🛠️ 1. Update Plan Design for Compliance

✅ ACA Affordability Threshold
The affordability percentage under the Affordable Care Act (ACA) rises to 9.96% in 2026 (up from 9.02% in 2025). Employers must ensure at least one plan offering meets this requirement using IRS safe harbors (W-2, rate-of-pay, or FPL).

✅ Out-of-Pocket Maximums (OOPM)

• Non-grandfathered plans: Must cap OOPMs at $10,600 (individual) and $21,200 (family).
• HDHPs: Must remain below lower thresholds: $8,500 (individual) and $17,000 (family).
  If offering family coverage, embed an individual OOPM not exceeding $10,600.

✅ Preventive Services
Ensure in-network preventive care services (like expanded breast cancer screenings) remain zero-cost to employees.

✅ Health FSA Limits
Monitor the IRS for updates to 2026 Health FSA contribution limits. (The 2025 cap is $3,300.)

✅ HDHP/HSA Contribution Adjustments
Make sure your HDHP minimum deductibles and OOPMs comply:

• Deductibles: $1,700 (individual), $3,400 (family)
• HSA Contribution Limits: $4,400 (individual), $8,750 (family), plus $1,000 catch-up for age 55+

✅ Telehealth for HDHPs
Decide whether to continue waiving deductibles for telehealth services. This is now permanently allowed without affecting HSA eligibility.

✅ EBHRA Contributions
Set your 2026 EBHRA allowance. The new cap is $2,200 (up from $2,150 in 2025).

💡 2. Ensure Wellness Program Compliance

If you offer health-contingent wellness programs, you must follow HIPAA nondiscrimination rules. Ensure materials clearly disclose reasonable alternatives to avoid penalties or unfair treatment.

🧠 3. Mental Health Parity Review

Check with your plan issuer or TPA to ensure your plan includes updated comparative analyses for nonquantitative treatment limitations (NQTLs) under MHPAEA.

📄 4. Distribute Required Notices

Ensure these notices are delivered on time and using the latest templates:

• SBC (Summary of Benefits & Coverage)
• Medicare Part D Creditable Coverage Notice (by Oct. 15)
• CHIP model notice (latest version from DOL)
• COBRA Initial Notice (within 90 days)
• SPDs/SMMs (every 5–10 years or upon changes)
• Patient Protection notices (for PCP designation plans)
• Grandfathered Plan status notice
• HIPAA special enrollment and privacy notices
• WHCRA (mastectomy coverage) annual notice
• SARs (if applicable, due 9 months post-plan year)
• Wellness Program Notices (ADA + HIPAA)
• ICHRA Notice (must be provided 90 days before plan year)

📢 5. Communicate Plan Changes Clearly

If your plan design is changing for 2026, update your SPD or issue a Summary of Material Modifications (SMM) to reflect those updates.

✅ Zinn Insurance Can Help You Stay Compliant

Navigating compliance updates is no small task. That’s where Zinn Insurance comes in. Our team of benefits experts helps employers like you understand complex regulations, stay ahead of deadlines, and streamline your open enrollment process.

💬 Need support preparing for 2026? Let’s talk.