Compliance Matters Newsletter | November 2026

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.

Additional Updates & Resources

Reminder: Gag Clause Attestations Due in December

Group health plans and health insurance carriers must annually submit a Gag Clause Prohibition Compliance Attestation (GCPCA). While the attestation filing deadline is still a few months away, now is a good time to begin coordinating with carriers, third party administrators (TPAs), pharmacy benefit managers (PBMs) and other vendors to confirm responsibilities, gather necessary information, and determine whether any contractual updates are needed.

Carriers will generally handle the attestation on behalf of fully insured group health plans. Service providers (e.g., TPAs and PBMs) may handle the attestation on behalf of self-funded group health plans, but otherwise the employer is responsible to attest.

New FAQs on Medical Expenses Related to Nutrition, Wellness and General Health

On September 23, 2026, the Internal Revenue Service (IRS) released an updated set of Frequently Asked Questions (FAQs) originally issued in March 2023. Those FAQs address expenses related to nutrition, wellness, and general health that are eligible for reimbursement through health savings accounts (HSAs), flexible spending accounts (FSAs), health reimbursement arrangements (HRAs), and Archer medical spending accounts (MSAs) only when they primarily diagnose, treat, mitigate, prevent a specific disease or affect a body structure or function.

The gray-area items that are not a simple yes or no answer, mostly depend on a physician-diagnosed condition. Nutritional counseling, weight-loss programs, and gym memberships only qualify when they treat a specific diagnosed disease such as obesity, diabetes, hypertension, or heart disease. Special foods or beverages qualify only when three conditions are met:

• They don’t meet normal nutritional needs:
• They treat an illness: and
• A physician substantiates the need.

Even if all the conditions are met, only the cost above normal food counts.

Activities that promote general fitness, such as swimming or dancing lessons, remain non-eligible expenses even if recommended by a doctor for overall health improvement.

The FAQs now also address wearable devices such as smart watches, rings, sensors, and similar technology. A device qualifies only if it is bought and primarily used to diagnose, treat, mitigate or prevent a specific disease. Factors such as medical recommendations, an individual’s diagnosis or risk factors, and how the data is used are important considerations. Accessories and software subscriptions associated with the device follow the same rule.

For more information about whether costs related to nutrition, wellness, and general health are medical expenses under § 213 of the IRS Code, see IRS Publication 502, Medical and Dental Expenses PDF and Tax Topic 502, Medical and Dental Expenses. For more information about HSAs, FSAs, Archer MSAs, and HRAs, see IRS Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans.

Proposed Rules for Premium Tax Credits

On October 15, 2026, the Internal Revenue Service (IRS) issued proposed regulations implementing the premium tax credit (PTC) changes enacted under the One Big Beautiful Bill Act (OBBBA) of 2025. The proposed rules would eliminate PTC eligibility for certain lawfully present immigrants with incomes below 100% of the federal poverty level who are ineligible for Medicaid due to immigration status beginning in 2026, expand restrictions on PTC eligibility for certain noncitizens starting in 2027, require taxpayers to repay the full amount of any excess advance premium tax credits (APTCs) beginning in 2026, and impose enhanced Exchange verification requirements for residency, citizenship or immigration status, income, family size, and other eligibility factors beginning in 2028. The regulations would also implement the OBBBA’s elimination of income-based special enrollment periods that are not tied to a qualifying event for plan years beginning in 2026.

These changes significantly tighten PTC eligibility, repayment, and verification requirements and may affect employees and family members who obtain health coverage through the Exchanges, making it important for plan sponsors and advisors to understand the new rules and their potential impact on Exchange enrollment and affordability assistance. Stakeholders may comment on the proposed rules by submitting comments electronically or by mail by November 30, 2026. EPIC will continue to monitor developments with the proposed rules and provide any necessary updates.

Allegheny County Paid Parental Leave & Sick Leave Update

On October 20, 2026, the Allegheny County Council approved a bill which creates a new paid parental leave (PPL) mandate and expands the county’s existing paid sick leave requirements.

The PPL applies to private employers with 15 or more employees (temporary and seasonal employees are excluded). Employees must have been employed at least 180 continuous days. Part-time employees must have worked 625 hours during that period to qualify. Eligible employees can take up to 12 weeks of leave within the first year of birth, adoption, legal permanent placement in foster care, or stillbirth (for recovery and behavioral health needs). The employer will pay 100% of wages up to a maximum weekly PPL benefit of $4,200.

Upon return from leave, employees must be restored to the same or an equivalent position held prior to leave. All employer benefits, including but not limited to medical, dental and vision coverage, must be maintained. PPL runs concurrently with the federal Family and Medical Leave Act (FMLA).

Paid sick leave changes:

• Employee threshold changed from 26 down to 15 employees.
• Accrual increases from 1 hour per 35 hours worked to 1 hour per 30 hours worked.
• Employers with 15+ employees must allow accrual/use of up to 72 hours of paid sick leave annually.
• Employers with fewer than 15 employees must allow accrual/use of up to 48 hours annually.
• Miscarriage and Still Birth Coverage – Added as a qualifying event with requirements and provisions.

Employers must implement the amendments required by the law no later than 180 days from the date the bill is signed or the employer’s next budget cycle, whichever occurs first. Beginning one year after the bill is signed, employers must file a certification that they have complied, and then annually.