The Affordable Care Act established the Patient-Centered Outcomes Research Institute (PCORI) to support research evaluating the effectiveness of medical treatments and healthcare delivery. To help fund this work, certain employer-sponsored health plans must pay an annual PCORI fee.
When employers think about fiduciary responsibility, retirement plans often come to mind first. But recent developments make it clear that fiduciary duties also matter—sometimes significantly—when it comes to employer-sponsored health and welfare plans.
As Marketplace health plan premiums rise and subsidies shift, employers are seeing more requests from employees (and their spouses) to drop Marketplace coverage and enroll in an employer-sponsored health plan mid-year. While this may feel straightforward, Marketplace rules and employer plan rules do not always work the same way.
Employer-sponsored group health plans must submit their 2025 Gag Clause Prohibition Compliance Attestation (GCPCA) to CMS by December 31, 2025, to confirm compliance with federal transparency rules. This annual filing covers the 2024 calendar year and applies regardless of employer size or funding arrangement.
In July 2025, the IRS released new guidance increasing both the affordability percentage and penalty amounts under the Affordable Care Act’s employer mandate for the 2026 plan year. These changes will affect how Applicable Large Employers (ALEs) determine affordability and assess compliance risk moving into the next benefits cycle.
In May 2025, the Departments of Labor, Health and Human Services, and the Treasury announced a temporary pause in enforcement of the 2024 final rule under the Mental Health Parity and Addiction Equity Act (MHPAEA), following a legal challenge brought by an employer coalition. This enforcement pause gives the agencies time to reexamine certain provisions and consider future revisions through the regulatory process.
