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.

December provided employers an opportunity to review year-end compliance to prepare for the new year. Employers confirmed that their worksite posters are appropriate for the type of business, number of employees, and state, and are the most recent version. Employers who are applicable large employers (ALEs) must be aware of potential penalties including those for not offering affordable coverage through employer contributions. Several states have implemented their own Individual Mandate, consequently employers in those states need to prepare for the type and timing of that reporting. December was also a good time to review retention and confidentiality requirements for employee files and employment-related records pertaining to group benefits.

November brought an FAQ from the Departments of Labor, Health and Human Services, and the Treasury ensuring that SBCs and claims and appeals notices are available when more than 10 percent of the population is literate only in a specific non-English language. UnitedHealth’s pharmacy benefit manager announced $35 insulin price caps, while BlueCross BlueShield continues moving into direct-care delivery. California takes a step toward a single-payer system, while Chicago introduced a paid leave and paid sick and safe leave ordinance.

October saw the release of adjusted civil penalties for HIPAA violations, ACA requirements, and Medicare Secondary Payer rules. Health plan limits and maximums for 2024 including high deductible health plans (HDHPs), health savings accounts (HSAs) flexible spending accounts (FSAs), and dependent care FSAs have been announced. Minnesota enacted a Paid Sick and Safe Leave Law to take effect on January 1, 2024, and California expanded its Paid Sick Leave. The IRS announced the annually adjusted Patient-Centered Outcomes Research Institute (PCORI) fee.

In September, plan sponsors began sending out Medicare Part D Creditable Coverage notices, and both Oregon and Maine announced Paid Family and Medical Leave laws. Sponsors of group health plans began completing the required Gag Clause Attestation due by the end of 2023. The Departments of Labor, Health and Human Services, and Treasury released guidance on complying with the MHPAEA, and are soliciting comments on ways to motivate participation by TPAs. The government once again offers free COVID-19 tests with home delivery.