Employers should be aware of the top compliance issues that may impact their health plan coverage for 2025. Some of these compliance issues are established requirements for employers, such as the new simplified reporting under the Affordable Care Act (ACA). Other compliance issues are anticipated developments employers should monitor, such as additional health care transparency requirements. It is uncertain what impact Republican control of Congress and the White House may have on health plan compliance issues, although there will likely be a shift in priorities related to health care policies.
Key Health Plan Compliance Issues for 2025
Other top health plan compliance issues employers should be aware of in 2025 include:
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New mental health parity requirements, including a fiduciary certification requirement for comparative analyses of nonquantitative treatment limitations (NQTLs).
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Possible new state and federal oversight of pharmacy benefit managers (PBMs) to help control health care costs.
Expiration of Telemedicine Exception for HDHPs/HSAsp>Expiration of the telemedicine exception for high deductible health plans (HDHPs).
Links and Resources
Simplified ACA Reporting
At the end of 2024, Congress passed two new laws, the Paperwork Burden Reduction Act and the Employer Reporting Improvement Act, which ease ACA reporting requirements for employers and set new limits on the IRS’ assessment of “pay-or-play” penalties.
As background, the ACA requires ALEs and non-ALEs with self-insured health plans to provide information to the IRS about the health plan coverage they offer (or do not offer) to their employees. They must also provide related statements to individuals regarding their health plan coverage.
The new laws ease ACA reporting requirements for employers as follows:
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Individual statements only required upon request: Before 2025, ALEs were required to provide each full-time employee with a statement regarding their health coverage (Form 1095-C) within 30 days of Jan. 31 each year. Starting in 2025, ALEs will only need to send Forms 1095-C and 1095-B to individuals if requested.
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Electronic consent for individual statements: Statements can be provided electronically if the individual has consented at any prior time, unless revoked in writing.
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Substituting birth dates for taxpayer identification numbers (TINs): Employers may use a covered individual’s birth date instead of a TIN without first making reasonable efforts to obtain the TIN.
ALEs are subject to IRS penalties if they do not offer affordable minimum essential coverage under the ACA’s employer shared responsibility (“pay-or-play”) rules. The new legislation increases the time ALEs have to respond to IRS penalty assessment warning letters from 30 days to 90 days. It also imposes a six-year time limit for the IRS to collect assessments.
Expiration of Telemedicine Exception for HDHPs/HSAs
Telemedicine gained popularity during the COVID-19 pandemic as a safe, remote health care option. However, for plan years beginning in 2025, the pandemic-era relief allowing HDHPs to cover telemedicine before deductibles are met has expired. This means:
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HDHPs must start imposing deductibles on telehealth services in 2025 to maintain HSA eligibility.
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Employees will need to pay the full cost of non-preventive telemedicine services until they meet their deductible.
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Employers should update summary plan descriptions (SPDs) and notify plan participants of changes.
New Fiduciary Certification Requirement Under MHPAEA
In September 2024, federal agencies released a final rule strengthening MHPAEA’s requirements. The U.S. Department of Labor continues to make MHPAEA compliance a top enforcement priority, particularly for NQTLs.
Starting with the 2025 plan year, employer-sponsored health plans must:
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Ensure their comparative analyses include a plan fiduciary’s certification that the plan engaged in a prudent process to select and monitor service providers.
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Reach out to issuers or third-party administrators (TPAs) to confirm that NQTL comparative analyses will be completed.
Reproductive Health Privacy
A final rule strengthens HIPAA privacy protections by prohibiting the disclosure of protected health information (PHI) related to lawful reproductive health care in certain situations. As of Dec. 23, 2024, these new protections prohibit PHI disclosure:
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For a criminal, civil, or administrative investigation related to reproductive health care.
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To identify an individual, health care provider, or other person for purposes related to such an investigation.
Employers with self-insured health plans or access to PHI should:
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Update HIPAA policies and train staff on new PHI restrictions.
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Review business associate agreements to determine if updates are needed.
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Update HIPAA privacy notices by Feb. 16, 2026.
Health Plan Transparency Reminders
Employers should review their compliance with health plan transparency requirements, including:
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Self-service price comparison tool: Health plans must provide real-time, personalized cost-sharing estimates.
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Machine-readable files (MRFs): Health plans must publicly disclose detailed pricing information and update it monthly.
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Surprise medical billing notices: Employers must post information on federal balance billing protections.
Other Potential Developments in 2025
Possible compliance developments that could impact health plan coverage include:
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Finalizing a HIPAA Security Rule update to strengthen cybersecurity protections for electronic PHI.
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New state and federal oversight of PBMs to control health care spending.
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State mandates requiring fully insured plans to cover fertility treatments.
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Ongoing litigation on ACA preventive care mandates and ERISA fiduciary requirements.
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Federal guidance on transparency requirements such as advanced explanation of benefits (EOBs).