Top Health Plan Compliance Issues for 2025

In 2025, the Affordable Care Act (ACA) reporting saw a simplification with Form 1095-C only needing to be distributed upon request. . The telemedicine exception for High Deductible Health Plans (HDHPs)/Health Savings Account (HSA) plans was also eliminated. Furthermore, new HIPAA privacy rights regarding lawful reproductive health care were established. 

Simplified ACA Reporting:

• Form 1095-C, which details employer-provided health coverage, no longer needs to be automatically sent to employees. 

• Instead, it is now only required to be furnished upon specific request from the individual. 

• Employers must still provide a notice informing employees of their right to request the form. 

• This change is expected to reduce the burden on employers associated with ACA reporting. 

• The IRS is providing guidance on how to implement this change, including the required notice. 

End of Telemedicine Exception:

• The previous exception allowing telemedicine to be offered in conjunction with HDHP/HSA plans has been removed.

• This means that telemedicine will now need to comply with the same requirements as other healthcare services offered under HDHP/HSA plans. 

HIPAA Privacy Rights for Reproductive Health Care:

• New HIPAA privacy protections strengthen the confidentiality of protected health information (PHI) related to lawful reproductive health care.

• These protections prohibit the use or disclosure of PHI for investigations or proceedings related to lawful reproductive health care.

• This change aims to protect individuals' privacy related to their reproductive healthcare choices. 

If you have any questions our benefits team is here and in your corner. You can reach us at 315-234-7500