Compliance Corner: New Gag Clause Attestations Due December 31st

The Gag Clause Attestation is being taken care of by most, but not all, carriers or administrators on behalf of their customers. This is a new requirement resulting from the Consolidated Appropriations Act (CAA) requires an annual Gag Clause Prohibition Compliance Attestation (GCPCA). 

The attestation confirms that group health plans and health insurance issuers offering group health coverage are prohibited from entering into an agreement with a provider or TPA that would restrict the plan from providing cost or care information to plan participants, accessing de-identified claims data, or sharing information per privacy regulations with a business associate.

Attestations are to be submitted via the CMS-HIO System.

The filing is due December 31, 2024. 

Ultimately, the plan sponsor is responsible. Penalties for not filing an attestation fall under the standard IRC 4980D penalty scheme, which is $100 per day per affected individual for noncompliance. However, all fully insured carriers are providing this service. Below is a short list of those who are NOT filing or it is unknown if they are filing.

Click here to download the full carrier guide.

If your carrier wasn’t listed, please reach out to your ARC representative or the administrator.

What to do if you have to file: DON’T WAIT

If your insurer is requiring that you handle the attestation, please start the process now. We can’t perform this duty on your behalf as we’re not legally permitted to do so.

This process is much simpler than the instructions would have you believe or other CMS filings we’ve done with customers in the past. We have some screenshots we can share upon request. 

If you have any additional questions, please don’t hesitate to reach out to your ARC representative.