Alerts

Before you leave for summer vacation, there are some compliance deadlines and best practices related to health plans to prepare for during the summer months.

June

RxDC Report Due (Prescription Drug Data Collection)

• Deadline: June 1, 2025 (for all health plans, regardless of plan year)
• Who: All group health plans
• What: Complete online submission with CMS. Submit the annual RxDC report, which covers prescription drug and healthcare spending data for 2024. Most employers will rely on their insurance carriers, third-party administrators (TPAs), or pharmacy benefit managers to prepare and file this report. 
• Action: Confirm with your vendors that the RxDC report has been filed on time. Since the penalties (up to $100/day) accumulate over time, filings should be completed as soon as possible, even if late.
  
  

July

PCORI Fee Payment

• Deadline: July 31, 2025 (for all plans, regardless of plan year)
• Who: Employers with self-insured health plans
• What: File Form 720 and pay the annual Patient-Centered Outcomes Research Institute (PCORI) fee using IRS Form 720.
• Amount of Fee:
  • For plan years ending on or after October 1, 2023, and before October 1, 2024, the PCORI fee is $3.22 per covered life.
  • For plan years ending on or after October 1, 2024, and before October 1, 2025, the PCORI fee increases to $3.47 per covered life.
  • Action: Ensure timely calculation and payment of the PCORI fee. The potential penalty is 25% of the amount that is underpaid per year.  

• Form 5500 Filing
  • Deadline: July 31, 2025 (for calendar-year plans, 7 months after the end of the plan year for non-calendar-year plans)
  • Who: ERISA-covered group health plans that do not qualify for the small plan exemption (generally, plans with 100+ participants)
  • What: File Form 5500 with the Department of Labor to report plan financials and operations. An automatic 2 ½ month extension (i.e., to October 15 for calendar year plans) is available by filing IRS Form 5558 by the due date.
  • Action: Prepare and file Form 5500 or request an extension if needed. Total potential penalties (if assessed by both the IRS and DOL) can exceed $2,670 per day for late filing. Employers who find themselves out of compliance can use the Delinquent Filing Voluntary Compliance (DFVC) process to cap the penalty at $4,000.   
       

August

No Major Federal Health Plan Deadlines – Get Ready for Fall

• There are no major federal health plan compliance deadlines specifically scheduled for August. However, use this month to: 
  • Review plan documents and compliance status
  • Prepare for upcoming fall notice distributions (e.g., Medicare Part D, CHIP, and WHCRA notices due in October)
  • Address any outstanding issues from June and July filings

Additional Reminders

Early Preparation for Annual Notices

• Although the Medicare Part D Notice of Creditable Coverage is due by October 15, 2025, employers should consider working with their insurance partners early in the summer to determine the plan’s creditable status, especially given changes under the Inflation Reduction Act that may affect plan status in 2025.
• Best Practice – To ensure timely distribution, many employers include the Medicare Part D notices with their annual open enrollment materials (assuming they are distributed on or before October 15). There is no penalty for late distribution, but employees or beneficiaries who miss Medicare Part D enrollment deadlines may have penalties under Medicare for late enrollment.
• Consider bundling other recommended notices (e.g., HIPAA Special Enrollment, Primary Care Provider Patient Protection) with annual distributions for efficiency, even if not strictly required.
  
  

Monitor for Vendor Communications

• Stay in close contact with your insurance carriers, TPAs, and pharmacy benefit managers to ensure all required reports and fees are submitted on time.

Review Internal Processes

• Use the summer months to audit your benefits administration processes and ensure compliance with all federal and state requirements.
  
  

Employers should ensure these deadlines are met to maintain compliance and avoid penalties while also using the summer as an opportunity to prepare for the busy fall notice season.

This Legal Update is not intended to be exhaustive, nor should any discussion or opinion be construed as legal advice. Readers should contact legal counsel for legal advice. All rights reserved.