Submit the Medicare Part D subsidy application to CMS to obtain Part D subsidy for the 2025 plan year. For calendar year retiree drug plans.
Applies to ERISA and non-ERISA plans seeking federal subsidies for providing retiree drug coverage. Generally, the application deadline is 90 days prior to the beginning of the plan year. An extension of approximately 30 days can be requested from the Centers for Medicare & Medicaid Services (CMS) before the application deadline.
December 15 - Distribute summary annual reports (SARs), if Form 5500 for a calendar year plan was filed under an extension.
Applies to calendar-year ERISA plans that filed Form 5500 under an extension.
For non-calendar-year plans, the SAR deadline is two months after the plan's extended 5500 filing deadline.
December 29 - Distribute any MLR rebate received from insurer that is considered to be plan assets.
Employers are required to distribute the portion of an MLR Rebate that is considered plan assets within 90 days of receiving the rebate (e.g., by December 29 if received on September 30). However, employers often determine that the rebate is not plan assets or can use the rebate on behalf of the plan. Those determinations need to be made and documented. In addition, plan sponsors who received a rebate prior to Sept. 30 may need to adjust their deadline for using the rebate.
December 31 - Submit to CMS the gag clause prohibition attestation (GCPCA).
Plans and issuers are required to attest to CMS that the plan or issuer is in compliance with the gag clause prohibition. Employers with self-funded or level-funded plans should contact their insurers to obtain that information and determine whether the carrier will file the attestation directly with CMS, as they would with fully insured plans. Employers with fully insured plans can rely on the carriers to do so, as it is their primary responsibility.
Attestations are filed directly with CMS here.
December 31 - Distribute Annual Notices (for calendar year plans) that were not included with Open Enrollment materials.
Distribute annual Women's Health and Cancer Rights Act notice, which applies to ERISA and non-ERISA plans. Self-insured state and local governmental plans may opt out.
Notice must be provided to participants (employees and retirees), COBRA and other beneficiaries receiving benefits, and alternate recipients under QMCSOs. This notice is typically distributed at initial enrollment and then annually, prior to each plan year. The model notice is available here.
December 31 - Distribute notice of premium assistance under Medicaid or the Children's Health Insurance Program (CHIP).
The notice must be provided to each employee, regardless of eligibility or enrollment status. The model notice is available here. It is a best practice to provide this as a separate document, but, as with most annual notices, it can be included with the plan's open enrollment materials.
December 31 and upon request - Provide nondiscrimination notice; also, must post on website and in physical location.
This notice applies to select employers that are covered by Section 1557 of the Affordable Care Act, such as:
This obligation is to include in these documents a nondiscrimination notice apprising employees of the employer's obligation to comply with section 1557. A model notice is available here.
Submit the Medicare Part D subsidy application to CMS to obtain Part D subsidy for the 2026 plan year. For calendar year retiree drug plans.
Applied to ERISA and non-ERISA plans seeking federal subsidies for providing retiree drug coverage. Generally, the application deadline is 90 days prior to the beginning of the plan year. An extension of approximately 30 days can be requested from the Centers for Medicare & Medicaid Services (CMS) before the application deadline.
October 15 - Distribute notices of creditable and/or non-creditable coverage (if not provided in the previous 12 months).
Provide this notice to employees, retirees, and dependents enrolled in Medicare and also enrolled (or seeking enrollment in) the employee's group medical plan.
Most employers provide these notices at open enrollment, and such notices are deemed given for the next 12 months unless there's a material change in the creditable or non-creditable nature of the coverage. Thus, if distributed in enrollment packets during the previous 12 months (and there's no material change in the Rx coverage), the mid-October deadline may be ignored.
These notices may be combined with other notices but must be "conspicuous." There must be a text box at the top of the packet noting in 14-point font that the packet includes a Medicare Part D notice. The notice may be mailed or hand-delivered; electronic distribution is possible, but special consent rules apply.
October 15 - Calendar Year Plans that extended 5500
File Form 5500 for the prior calendar year plan year, if filing under an extension from a July 31 deadline.
Increase Dependent Care Flexible Spending Account (effective 2026) to $7,500 ($3,750 for married filing separately).
Student Loan Repayments as part of employer educational assistance plans (the annual limit is $5,250 for all educational expenses).
Telehealth Expansion for HSAs - determine whether the medical plan will include telehealth reimbursements below the high-deductible health plan minimum ($1,700 individual/$3,400 family).
Consider adding a Direct Primary Care component (up to $150/month for individuals and $300/month for families that can be purchased without disqualifying the HSA).
First day of open enrollment - Distribute the Summary of Benefits and Coverage (SBC).
The SBC is distributed to all benefit-eligible employees during open enrollment for employees who make benefit elections. For all others, such as those with automatic re-enrollment, the SBC must be provided 30 days before the start of the plan year.
First day of open enrollment - Michelle's Law notice if the plan covers full-time students over age 26.
First day of open enrollment - Distribute HIPAA special enrollment notice.
Provide participants with open enrollment packets (or by the end of the year). A DOL model notice is available here.
First day of open enrollment - Self-funded (and most level-funded) plans - distribute HIPAA privacy notice.
Provide all enrolled individuals (delivery to the enrolled participant is deemed to be delivered to all their dependents). If a dependent requests a copy of the notice, the plan must supply it.
Generally, this will be included with open enrollment materials.
Insured plans generally do not distribute the forms as the carriers are required to do so. However, if an insured plan received PHI, the plan sponsor must provide this notice upon request.
First day of open enrollment - Distribute notice of availability of alternative standards to maintain a wellness program.
When an employer operates an activities-based or outcomes-based wellness program subject to the ACA, wellness program materials must include a notice stating that, if an individual is unable to satisfy the employer's desired standard (or it would be unwise to try), the employer will fashion an individualized alternative standard for the individual.
A specific timing for distribution is not addressed in the regulations; however, such disclosure must be included in all plan materials describing the terms of the program (written or online).
Regulations include model language that can be used to satisfy the disclosure requirement.
Plan materials are not required to describe a specific, reasonable alternative standard; only the availability of one is required. The plan may accept the recommendations of the individual's physician as the appropriate alternative standard and, in some cases, may be required to do so.
Other notices that may be included at open enrollment:
October 30 - San Francisco HCSO contributions for prior calendar quarter.
October 31 - Washington Cares tax (fully insured and self-insured ERISA plans file report and remit payment of payroll tax withholdings from Q3 for Washington workers).
November 15 - Report and pay the Washington Partnership Access Line WAPAL Fund Assessment (all assessed entities with covered lives in Washington file Q3 covered lives reports and pay quarterly assessments).
November 15-December 15 - File the Massachusetts Health Insurance Reporting Disclosure (HIRD) form.
December 31 if not done earlier - Illinois: Notify eligible employees of benefits provided by the employer's group medical plan, compared to Illinois's EHB package.
First day of open enrollment - Provide FSA participants in California with notice regarding any deadline to withdraw FSA funds prior to the end of the plan year.
December 31 –
Determine W-2 reporting information for all employees including the health plan value (aggregate cost of health plan – both employer and employee contributions) that is reported on Form W-2 Box 12. This is optional for employers with fewer than 250 W-2s for the year.
Determine any imputed income (from items such as group term life in excess of $50,000 or a discriminatory portion of a self-funded health plan that discriminates in favor of highly compensated individuals). This will be reported on the 2025 W-2 that is distributed in January 2026.
Determine information to be reported on health plan Form 1095 (that informs the plan participants their coverage status with respect to the employer health plan) to be distributed to plan participants in 2026, and Form 1094 that reports the 1095 information to the IRS.
This 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.