By: HUB’s EB Compliance Team

Ah yes, another year-end to-do list — because what benefits professionals really need right now is more items on their already overflowing plate. But hear us out...

The One Big Beautiful Bill Act “OBBBA” and other guidance brought changes this year that plan sponsors may want to consider in addition to the traditional, not so new, action times that “present” themselves this time of year. Creating your own checklist will help say goodbye to the current year and provide a fresh start for the new one. The following are some of the key considerations and action items plan sponsors should address prior to the end of this year or at least prioritize in early 2026:

  • Telehealth Coverage…to charge or not to charge, that is the question! The OBBBA made pandemic-era relief related to telehealth coverage on high-deductible health plans permanent. This means that plan sponsors can provide telehealth services prior to the deductible being met while still preserving employee eligibility to make health savings account (“HSA”) contributions. Moving forward, employers may choose to provide telehealth services at no cost to participants, charge the fair market value of the cost of services until the deductible is met, or charge anything in between. The good news for plan sponsors is that the relief is retroactive to January 1, 2025, so if it wasn’t on your radar last year you are not out of compliance.
  • Dependent Care Contribution Limits… should you increase the limit? Under OBBBA, and starting with tax years beginning after December 31, 2025, the maximum annual contribution limit for Dependent Care Assistance Programs (“DCAP”) will increase from $5,000 (or $2,500 for married individuals filing separate tax returns) to $7,500 (or $3,750 for married individuals filing separate tax returns). While the cost of childcare has consistently increased, the annual contribution limit for DCAPs has not increased since 1986. Keep in mind however, that nondiscrimination rules have not changed. If your plan has had trouble passing dependent care nondiscrimination testing in the past, increasing the limit may not be right for your plan as it could exacerbate the failure and have an even bigger impact on plan participants.
  • Direct Primary Care Arrangements… some arrangements can be paired with an HSA. A Direct Primary Care Arrangement (“DPC”) is an arrangement under which an individual is provided medical care consisting solely of primary care services provided by primary care practitioners, and the sole compensation for such care is a fixed periodic fee not to exceed $150 per month for the individual, or $300 per month for DPCs covering more than a single individual. For purposes of this definition, “primary care services” shall not include:
    • Procedures that require the use of general anesthesia,
    • Prescription drugs (other than vaccines), and
    • Laboratory services not typically administered in an ambulatory primary care setting.

OBBBA now permits high-deductible health plan (“HDHP”) participants to also enroll in DPC arrangements while maintaining their eligibility to contribute to an HSA. Additionally, individuals participating in a DPC arrangement directly may use HSA funds to reimburse DPCA membership fees.

  • Remember Gag Clause Attestations. Employers and their service providers must attest to the government no later than December 31st each year that their plans are not subject to any gag clauses that would prohibit disclosure of provider cost or quality data or deidentified claims and encounter data as required as part of the Consolidated Appropriations Act (“CAA”). As explained in our earlier article, additional guidance released earlier this year requires that plan sponsors also attest that provider agreements do not contain restrictions in any downstream agreements, limitations on sharing deidentified data with business associates, or restrictions on sharing de-identified data as part of a claims audit or review. While most insurers and third-party administrators (“TPA”) will attest on the employer’s behalf, self-funded plan sponsors should confirm attestation by their vendors in writing (and maintain records of such correspondence) as a best practice.
  • Revisit Last Year’s ACA Reporting “Present”. Employers should determine whether to take advantage of Affordable Care Act (“ACA”) reporting relief if they haven’t done so already. Late last year (December 2024) the Departments issued reporting relief allowing employers to avoid providing individual Forms 1095-C to employees. Unfortunately, the relief was issued too late for many employers to take advantage of it. Guidance released earlier this year clarified action items specifically requiring that:
    • Employers must post a clear, conspicuous, and accessible notice on a website accessible to all full-time employees written in plain, non-technical terms and in letters large enough to call their attention to the fact that it pertains to a tax statement.
    • The notice explains how responsible individuals may request a copy of Form 1095-C including the employer’s email address, mailing address, and telephone number.
    • The statement is posted no later than the deadline for furnishing the Forms 1095-C, plus extensions.
  • Update HIPAA Notice of Privacy Practices. Self-funded plan sponsors may believe that there are no action items required because Reproductive Health Rules were vacated, however, they are not off the hook completely. Rules addressing the confidentiality of substance use disorder patient records may require updates due no later than February 16, 2026.
  • Mental Health Parity & Addiction Equity Act (“MHPAEA”) NQTL Compliance Still Required. While the Departments issued a policy of nonenforcement applicable to MHPAEA final rules issued in 2024, compliance with non-quantitative treatment limitation (“NQTL”) comparative analysis requirements is still required by insurers and self-funded plan sponsors. Specifically, self-funded plan sponsors should update their NQTL analysis so that it is available if requested by a regulator or plan participant.
  • Routine Year-End Housekeeping items including but not limited to:
    • Making any necessary updates to plan documents and plan disclosures
    • Providing an opportunity for employees to review and confirm elections before the plan year starts because cafeteria plan rules generally do not allow changes once the plan year starts without a permitted change in status event.
    • Reviewing any potential payroll reporting updates that may be required as the result of benefits changes. For example, an increase in employer provided life insurance in excess of $50,000 requires imputed income for those amounts.
    • Updating ACA affordability and safe harbor reporting methods as necessary with ACA reporting providers to comply with reporting requirements on Forms 1095-C.
    • Self-funded Health Plan and Cafeteria Plan Nondiscrimination Testing. While we mentioned DCAP plans specifically above, self-funded health plans and Section 125 pretax plans (including Health FSAs) are subject to testing too.

If you have any questions, please contact your HUB Advisor. View more compliance articles in our Compliance Directory.

NOTICE OF DISCLAIMER

Neither HUB International Limited nor any of its affiliated companies is a law or accounting firm, and therefore, they cannot provide legal or tax advice. The information herein is provided for general information only and is not intended to constitute legal or tax advice as to an organization’s or individual's specific circumstances. It is based on HUB International's understanding of the law as it exists on the date of this publication. Subsequent developments may result in this information becoming outdated or incorrect, and HUB International does not have an obligation to update this information. You should consult an attorney, accountant or other legal or tax professional regarding the application of the general information provided here to your organization’s specific situation in light of your or your organization’s particular needs.