Compliance reminders and seasonal action items for group health plan sponsors

As we head into spring and the renewed hope that your favorite MLB team will show some promise this season, now is a great time to confirm your health and welfare plan administration is tracking the year's key notices, filings, and operational requirements. Below is a practical checklist of common compliance items for employers that sponsor group health plans. 

Spring Compliance Deadlines (At a Glance)

• PCORI fee (IRS Form 720): For most calendar-year plans, the filing and payment are due July 31. Confirm whether your plan is self-insured (including HRAs and level-funded plans) and who will file. The fee adjusts each year. The fee for plan years that ended after September 30, 2024, and before October 1, 2025, is $3.47, and for plan years that ended after September 30, 2025, and before October 1, 2026, is $3.84.
• ACA reporting (Forms 1094/1095): If you filed earlier this year, keep records, resolve any IRS "B" notices, and confirm ongoing measurement/stability period administration. 
• Medicare Part D creditable/non-creditable coverage notice: Typically distributed annually before October 15; use spring to verify your vendor process and retiree/COBRA populations.
• Prescription Drug Data Collection (RxDC): Confirm RxDC completion by vendors and their attestations regarding the amounts. Due dates can shift; confirm current year instructions and ensure your carrier/TPA has your plan and employer data well ahead of any deadline. For the due date of June 1, 2026, carriers should have already received the information.
• Forms 5500: For calendar year plans, these are due July 31. Employers should follow up with vendors to make sure necessary information is being gathered if they want to avoid an extension. 

Required Notices and ERISA Disclosures

• Summary Annual Report (SAR): If required for your plan, confirm preparation and distribution timing (often tied to Form 5500 filing dates and extensions). Due 9 months following the end of the plan year or two months following an extension of the 5500. 
• Marketplace Notice: Ensure the initial notice is still part of onboarding for new hires. 
• HIPAA Special Enrollment Rights: Verify the annual reminder is included with open enrollment materials (and available upon request). 
• Women's Health and Cancer Rights Act (WHCRA) and Newborns' and Mothers' Health Protection Act (NMHPA): Confirm annual/initial notice delivery with enrollment materials.
• CHIPRA Notice: For employers with employees in applicable states, confirm the annual notice is distributed (often at open enrollment) and that the current model notice is used.

COBRA: Operational Check-Up

Most employers use a vendor for COBRA administration. Nevertheless, the ultimate responsibility is that of the employer. Therefore, employers should confirm the following items with those vendors. 

• Notice timing and content: Confirm initial and election notices are sent on time and reflect your current plan options, premium amounts, and payment addresses.
• Qualifying events: Validate HR/benefits processes for terminations, reductions in hours, divorce/legal separation, dependent status changes, and Medicare entitlement.
• Premium administration: Ensure grace periods, coverage start/stop dates, and reinstatement rules are applied consistently. This is one area that is often overlooked. As the plan costs change, the premium cost share for the COBRA qualified beneficiaries should be adjusted accordingly. Typically, plans charge the maximum permitted under COBRA of 102% (or 150% during any extension due to a disability) of the plan costs for the applicable coverage level.

HIPAA Privacy and Security (Especially for Self-Insured Plans)

• Business Associate Agreements (BAAs): Confirm BAAs are in place and up to date with vendors that handle protected health information (PHI). More importantly, confirm that the vendors are also acting accordingly, not just asserting that they are. Recent legislation requires a more active role by the employer in this regard. A periodic audit of the vendors' processes might be appropriate.
• Plan documents: Make sure your plan document/administrative materials reflect HIPAA privacy and security requirements applicable to your plan design.
• Training: Refresh workforce training for anyone who accesses PHI (HR, benefits, payroll, IT security, etc.).
• Security practices: Review access controls, MFA, encryption standards where applicable, secure file transfers, and retention/destruction practices. 
• Incident response: Confirm you (and the appropriate vendors) have a breach response workflow (who to notify, how to investigate, and required notices).

Section 125 Cafeteria Plan and Payroll Alignment

• Plan document consistency: Confirm payroll deductions, eligibility, and election rules match your cafeteria plan document. 
• Midyear election changes: Re-train staff on permitted change events and required documentation; confirm your systems enforce the rules. 
• FSA administration: Validate carryover/grace period settings, runout dates, and communications for health FSA and dependent care FSA. 
• Leaves and return-to-work: Confirm processes for unpaid leave, premium catch-up, and reinstatement of coverage elections. 
• Nondiscrimination testing: Particularly important for dependent care assistance plans (referred to as DCAP or dependent FSAs). Cafeteria plans rarely discriminate in favor of highly compensated individuals. However, periodic testing is the only method to know for sure. DCAPs do fail testing periodically. By testing early in the year, employers can project potential results and make changes early in the year to avoid a year-end scramble to address the problem. 

Mental Health Parity (MHPAEA): Documentation Readiness

Fully insured plans—the carriers take this process on, and the employers can rely on the carriers to do so. As with any compliance item, it is a good practice to retain the evidence that the carrier has complied with this obligation. 

Self-funded plans (including level-funded plans) will need to be responsible for this process. The carriers have not generally agreed to provide the necessary information. 

• Comparative analyses for NQTLs: If your plan is subject to MHPAEA (almost all medical plans are), confirm you can produce (and keep updated) the required comparative analysis for non-quantitative treatment limitations (e.g., prior authorization, step therapy, fail-first rules, network admission standards). 
• Vendor coordination: Identify who will deliver the analysis (carrier/TPA/PBM) and how you will review and retain it. 
• Operational consistency: Spot-check claims and appeals administration for behavioral health/substance use disorder benefits versus medical/surgical benefits.

Transparency and Pharmacy-Focused Compliance

Fully insured plans—the carriers take this process on, and the employers can rely on the carriers to do so. 

Self-funded plans (including level-funded plans) will need to be responsible for this process. The carriers have not generally agreed to provide the necessary information. Therefore, plan sponsors will generally need to prepare, review, and retain the required documentation. 

• Machine-readable files (MRFs): Confirm your carrier/TPA is posting required MRFs and that links are accessible, current, and retained.
• Gag clause prohibition compliance attestation: Confirm your process to complete the annual attestation (often handled with vendor support).
• RxDC: Validate that your carrier/TPA/PBM has the data needed from you (EIN, plan year, plan name/number, premium equivalents, etc.).
• No Surprises Act: Confirm that the plan has processes for providing the Advanced Explanation of Benefits (where applicable), handling surprise billing disputes, and ensuring ID cards and plan materials include required information. 

Conclusion - Consider meeting with your benefits advisor, ERISA counsel, or TPA to confirm which items apply to your plan design (fully insured, self-insured, grandfathered status, size, and state requirements.

Disclaimer: This material is provided for informational purposes and does not constitute legal, tax, or accounting advice. Consult your advisors regarding your specific circumstances.