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.
What is a gag clause?
A gag clause is a contractual term that prevents a health plan from accessing or disclosing cost or quality information about care—such as provider reimbursement rates or de-identified claims data. The federal Consolidated Appropriations Act (CAA) prohibits plans and insurers from agreeing to such clauses in contracts with providers, networks, or TPAs.
What is the attestation?
The Gag Clause Prohibition Compliance Attestation (GCPCA) is an online submission confirming that your plan does not contain any prohibited gag clauses. Employers must submit an attestation for each health plan they sponsor, and the filing must be made through CMS’s Health Insurance Oversight System (HIOS).
Who is responsible for filing?
- Fully insured plans: The carrier is responsible, but employers should confirm in writing that the filing will be handled.
- Self-funded or level-funded plans: The employer (plan sponsor) is responsible under federal law, even if a TPA administers claims. Most TPAs do not file automatically, so confirm in writing whether yours will assist.
How to file
Submit the attestation via the CMS HIOS portal: https://hios.cms.gov.
Each plan must be registered individually, and CMS offers technical guidance online. If this is your first time using HIOS, begin the registration process early.
What happens if you don’t file?
Failure to comply may result in penalties of $100 per day per affected individual, in addition to the risk of audits or investigations by federal agencies.
Compliance tips
- Don’t assume your TPA or carrier is filing—get written confirmation.
- Retain documentation of your attestation and related communications for at least six years (or longer if your organization follows a seven-year record retention policy).
- Start early. Delays in registration or vendor responses can impact your ability to file on time.
This article is for informational purposes only and does not constitute legal advice. Employers should consult legal counsel or a qualified advisor before making compliance decisions.
For more Employee Benefits resources, contact INSURICA today.
This article is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel or an insurance professional for appropriate advice.Â
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