As we move into the second quarter of 2025, employers must stay ahead of critical health plan compliance updates. With new ACA reporting rules, mental health parity requirements, and health care transparency mandates taking shape, now is the time to ensure your organization is prepared.
🔹 Simplified ACA Reporting
Starting in 2025, employers will no longer need to automatically send Forms 1095-C and 1095-B—instead, they’ll be provided upon request. New rules also clarify electronic consent and allow birthdates in place of taxpayer IDs.
🔹 Telemedicine & HDHPs
The temporary telemedicine exception for HDHPs expired at the end of 2024. Without an extension, employees must now meet their deductibles before telehealth services are covered—unless new legislation is passed.
🔹 Mental Health Parity & Fiduciary Requirements
Under the new MHPAEA rule, employer health plans must provide comparative analyses of mental health benefits vs. medical benefits. ERISA-covered plans now require fiduciary certification to ensure compliance.
🔹 Reproductive Health Privacy Updates
New HIPAA protections restrict the disclosure of reproductive health-related PHI in legal proceedings. Employers must update HIPAA policies and train staff accordingly.
🔹 Health Plan Transparency
Employers must ensure compliance with:
✅ Self-service price comparison tools for participants
✅ Machine-readable files (MRFs) with pricing data
✅ Surprise medical billing protections
✅ Annual Rx spending reports and gag clause attestations
With potential new regulations on pharmacy benefit managers (PBMs) and federal cybersecurity rules, 2025 will be a pivotal year for employer-sponsored health plans. Now is the time to review policies, work with TPAs, and ensure compliance.
Zinn Insurance specializes in helping businesses stay compliant. Our team of experts provides guidance and support to ensure your company meets all requirements efficiently.
📞 Call us today to discuss your compliance strategy and avoid unnecessary risks!
