October brought the second of two Centers for Medicare & Medicaid Services (CMS) Medicare Part D annual disclosures, in the form of Creditable Coverage Letters. The IRS released the 2025 cost-of-living adjustment information affecting employee benefit plans. We were reminded that while there are no federal requirements for time off to vote, many states mandate it. Employers sponsoring an individual coverage HRA (ICHRA) should have provided their annual notice to plan participants. An FAQ was released providing guidance on the requirements of the Women’s Health and Cancer Rights Act. As open enrollment begins for many employers, remember important tips to remain compliant.

September brought the due date for the Summary Annual Report, which summarizes the Form 5500 contents. Employers prepared to send out the required Medicare Part D Creditable Coverage letters to eligible participants and enrolled beneficiaries. The Departments released final rules on the MHPAEA NQTL analysis. California insurers are required to cover in-vitro fertilization for large groups. The IRS released the 2025 ACA affordability percentage, and the DOL updated cybersecurity guidance for health and welfare plans.

In August, the FTC ban on non-compete agreements was struck down by a court stating that the FTC did not have the power to implement the ban and that its application was too broad. The FDA approved new and updated COVID-19 vaccines for adults and children as part of the preventive care mandate for group health plans. The Biden administration released its Unified Agenda, containing regulations impacting group health plans, and announced their anticipated release dates. New Hampshire announced an improved prior authorization process. The Johnson & Johnson breach of fiduciary trust lawsuit saw some movement and a similar suit was brought against Wells Faro and its fiduciaries.

July was a busy month for sponsors of group health plans. The final DOL rule on overtime exemption requirements went into effect July 1. IRS Form 5500, due on July 31 for calendar year plans, applies to most public and private sector businesses providing plans to 100 or more participants. Also due by July 31 was the annual PCORI fee, submitted via Form 720 by employers sponsoring self-funded medical plans or applicable HRAs. CMS announced updated parameters for Medicare Part D prescription coverage that will impact employers who need at provide documentation of creditable coverage to employees by October 31 and to disclose to CMS its creditable coverage within 60 days of the start of the plan year.

June saw the ACA Preventive Care Mandate upheld, with an exception that could open it up for future challenges. There was more movement on reproduction rights and privacy, where healthcare providers are barred from disclosing sensitive information to law enforcement without patient consent. Enforcement began on the Pregnant Workers Fairness Act (PWFA), which mandates that employers provide reasonable accommodations to employees affected by pregnancy, childbirth, or related medical conditions. The Supreme Court issued a unanimous decision in upholding the FDA's current protocol for mifepristone, commonly known as the abortion pill. Employers prepared to file IRS Form 5500.

In May, employers sponsoring self-funded medical plans or an applicable HRA began preparing to submit the PCORI fee, due July 31. The IRS released inflation-adjusted amounts for 2025 HSAs, EBHRAs, and HDHPs. The ACA Section 1557 nondiscrimination regulations were finalized, broadening the definition of impacted entities. The Medical Debt Cancellation Act was introduced, aiming to eliminate medical debt in certain circumstances. Connecticut Paid Sick Leave was expanded.

In April, a ban went into effect for most non-compete clauses, and the Centers for Medicare and Medicaid Services (CMS) portal opened for RxDC reporting submissions due June 1, 2024. The Equal Employment Opportunity Commission (EEOC) released final regulations mandating how employers with 15 or more employees must handle accommodation requests for pregnancy, childbirth, or related conditions, and published its final enforcement guidance on workplace harassment. The Department of Health and Human Services (HHS) introduced legislation safeguarding protected health information (PHI) related to reproductive health care.

ACA reporting is in its first year of the required electronic reporting for employers filing ten or more returns annually. Employers and employees must make changes to HSAs by the April 15 deadline. Employers of all sizes continued to prepare for the June 1 RxDC Reporting using the newly released instructions. New York City enacted a provision allowing individuals to initiate a private legal action for non-compliance with the Earned Sick and Safe Time Act.

February saw a potential industry-changing lawsuit against Johnson & Johnson and its plan fiduciaries asserting a breach of fiduciary duties and mismanagement of Johnson & Johnson’s prescription drug benefits program, costing its ERISA plans and employees millions of dollars in the form of higher payments for prescription drugs, as well as higher premiums, deductibles, coinsurance, and copays, resulting in lower wages or limited wage growth. A UnitedHealthcare company, Change Healthcare, was the target of a cyberattack potentially impacting more than 100 million members. Instructions for this June’s RxDC reporting have been updated, moving certain data from vendor aggregating into plan sponsor responsibility. The 2025 Employer Shared Responsibility indexed penalties have been released.

January was a relatively quiet month on the employee benefits compliance front. The Wage and Hour Division of the Department of Labor (DOL) introduced a new rule laying out the guidelines employers can follow to determine how to classify workers. The DOL also released Part 64 of its FAQs about Affordable Care Act (ACA) Implementation, to address coverage for preventive services and contraceptives and provide guidance on reasonable medical management techniques for contraception. California's Labor Commissioner updated its FAQs to reflect changes to the Healthy Workplaces Healthy Families Act (HWHFA), including the mechanics of accumulation, carry over, and use of benefits. New York Governor Kathy Hochul proposed an expansion of the state’s paid family leave to include time for prenatal medical appointments.