Navigating Compliance for 2024-2025 Open Enrollment

Click to Watch Recording

Speaker: Sarah Borders, CEBS ??

In a recent session led by compliance expert Sarah Borders, we explored the latest in healthcare compliance, essential updates for 2024-2025, and best practices for open enrollment. Here’s a comprehensive look at what you need to know to ensure a smooth and compliant benefits season.

CAA Compliance & Gag Clause Prohibition

The Consolidated Appropriations Act (CAA) brings new compliance responsibilities, particularly with the gag clause prohibition. To ensure compliance:

Annual Attestations: Both fully insured and self-insured plans must complete gag clause attestations by December 31st via the CMS web portal.

• Fully insured plans: Can transfer liability to the insurance carrier.
• Self-insured plans: Plan sponsors retain legal responsibility.
• Exemptions: Standalone dental/vision, FSAs, HRAs, and ICHRAs are exempt from these requirements.

2024-2025 Updates: New Limits & Notices

Key updates were highlighted for the upcoming year, impacting high-deductible health plans (HDHPs), flexible spending accounts (FSAs), and more:

• Increased HDHP Limits and FSA Contributions: New limits offer enhanced flexibility for participants.
• Fixed Indemnity Notice Requirement: Employers must be aware of this new requirement to ensure compliance with fixed indemnity offerings.
• HIPAA Policy Updates: Self-funded employers, in particular, need to review and update HIPAA training, policies, and procedures to align with current standards.

ACA Affordability for 2025

With the Affordable Care Act (ACA) affordability threshold set at 9.02% for the 2025 plan year, Sarah provided guidance on calculating affordability, especially for low-wage employees.

• Safe Harbors Explained: There are three safe harbor methods to determine affordability – federal poverty level, rate of pay, and W2 wages.
• Example Calculations: The session included practical examples, with a focus on using the rate of pay method to set affordable premiums for the lowest-paid employees.

Open Enrollment Reminders

With open enrollment around the corner, here are key reminders to maintain compliance:

• Notify COBRA and FMLA Employees: Ensure these participants are informed of their rights to enroll.
• Prevent Benefit Overlap: Verify that general-purpose FSAs/HRAs don’t overlap with HSAs, preserving eligibility.
• Required Notices: Distribute all mandated notices to employees before open enrollment.
• Document Elections: Collect all pre-tax elections in writing.
• Review ACA Reports: Analyze ACA look-back measurement reports for variable-hour employees to avoid penalties.

Final Takeaways

As we head into the 2025 benefits season, Sarah emphasized several action items:

1. Review Contracts: Ensure all contracts reflect current compliance standards.
2. Update HIPAA Policies: Adjust training and documentation for self-funded employers.
3. Maintain ACA Compliance: Confirm affordability percentages and review measurement reports.

By proactively addressing these updates and requirements, employers can enter 2025 with confidence in their compliance efforts!

Click to Watch Recording