Compliance Matters Newsletter | October 2025

Let our team help you navigate the ever-changing benefits compliance landscape each month. Check out this month’s latest alerts, additional updates, and resources hot off the press:

Employee Benefits Compliance Alerts

This month’s Compliance Matters newsletter provides a comprehensive review of the following topics. To obtain your copy, please use the form below to download.

• Court Vacates Contraceptive Coverage Exemption
• 2025 State Regulation Series: Court Grants Motion to Dismiss in Arkansas PBM Lawsuit
• Employee Benefits Litigation Series: Employer Wins ACA Penalty Challenge
• 2025 State Regulation Series: TX SB 1332 Provides Flexibility for Termination of Coverage Requirements
• 2025 State Regulation Series: San Francisco Health Care Ordinances: HCAO, HAO & HCSO

Additional Updates & Resources

Be on the Lookout for MLR Rebates

It’s the time of year for carriers to release Medical Loss Ratio (MLR) rebates to fully insured clients. Insurers of fully insured policies are required to distribute these payments annually by September 30. Employers who receive checks need to determine how much of the rebate is Plan assets and decide how to handle those assets. The Employee Retirement Income Security Act (ERISA) has strict rules around the use of plan assets. In most cases, they must be distributed within 90 days of the employer’s receipt of the rebate. For more information on MLR rebates and how to distribute them, access our August 2024 Alert.

Gag Clause Prohibition Attestations Due in December

The Consolidated Appropriations Act of 2021 (CAA) prohibits group health plans and health insurance carriers from entering into agreements with providers, third-party administrators (TPAs), or other service providers that include language that constitutes a “gag clause.” The first attestation was due by December 31, 2023, and subsequent attestations are due annually by December 31, making the next submission due December 31, 2025.

The gag clause prohibition and attestation requirements apply to all group health plans, but not excepted benefits, retiree-only plans, or account-based plans. Both fully insured and self-funded plans are subject to the requirements, as well as grandfathered plans, grandmothered plans, plans governed by the Employee Retirement Income Security Act (ERISA), and non-ERISA plans.

Centers for Medicare and Medicaid Services (CMS) created a webpage with information about how to comply with the gag clause prohibition, as well as how to attest to compliance. This webpage is the hub for resources and information from CMS on the gag clause prohibition and attestation requirement, and includes a link to the webform for submitting the attestation. For the 2025 attestation period, there are no changes to prior submission requirements or instructions as of the date of publication of this alert.

For questions about the process or to report difficulties with the attestation process, employers or reporting entities should email CMS directly at .

EPIC has created informational resources for our clients’ use. Please reach out to your EPIC account team for more information about how to access these resources. Previous alerts on the gag clause prohibition attestation and a webinar on the attestation requirement and submission process are available below:

• August 2023 Alert
• November 2023 Alert
• July 2023 Webinar

Many Employee Benefits-Related Rules on the DOL Spring Agenda

The Department of Labor’s (DOL’s) Spring 2025 regulatory agenda includes several health and welfare benefit plan initiatives focused on transparency, nondiscrimination, and disclosure requirements. Overall, the agenda shows a continued regulatory push toward participant protections and plan transparency. Items of interest for health and welfare benefits include:

• Default electronic disclosure/notice rules;
• Further transparency into pharmacy benefit manager fee disclosures;
• Guidance for the advanced explanation of benefits;
• Provider nondiscrimination requirements;
• Requirements for air ambulance services; and
• Clarification for broker disclosures.

The DOL’s full spring agenda can be found here: Agency Rule List – Spring 2025.

Monthly FAQ: How soon after employee HSA salary deductions are taken must they be forwarded to an HSA trustee?

Generally speaking, health savings accounts (HSAs) are not subject to the Employee Retirement Income Security Act (ERISA); however, the Department of Labor (DOL) has indicated that employers must promptly transmit employees’ HSA contributions to employees’ HSAs, because the DOL plan asset regulations apply to all workplace HSAs regardless of whether they are subject to ERISA. This rule applies to both pre-tax HSA contributions made by employees through cafeteria plan salary reductions and after-tax contributions made outside such a plan. Under the DOL’s plan asset regulations, participant contributions become plan assets as of the earliest date on which they can reasonably be segregated from the employer’s general assets, but in no event later than 90 days after the payroll deduction is made.