As 2025 closes, several pressing compliance issues will shape your responsibilities in 2026. Updated PCORI fees, Affordable Care Act (ACA) reporting obligations, state-level mandates, and new federal requirements such as gag clause attestations are all on the horizon.
Health benefit costs are projected to rise nearly 9% in 2026, putting significant pressure on employers to balance affordability with employee satisfaction. Against this backdrop, artificial intelligence (AI) is emerging as a transformative tool in the benefits space.
As 2025 draws to a close, employers and benefits professionals face a shifting regulatory landscape that will shape health and welfare programs in 2026 and beyond. This year’s developments underscore the government’s dual priorities: expanding access, modernizing benefit delivery, and balancing compliance with practical flexibility. Below is a roundup of the most significant regulatory highlights.
In 2025, personalization has moved from “nice to have” to “non-negotiable.” Employees expect benefits that reflect their individual needs, values, and life stages. Static, one-size-fits-all plans are being replaced by flexible, modular offerings that empower employees to choose what matters most.
In 2025, family-building support has emerged as a defining priority in employee benefits strategy. Fertility coverage, inclusive parental leave, and caregiving support are no longer niche offerings — they’re central to how employees evaluate workplace value. As life paths diversify and caregiving responsibilities expand, benefits managers are rethinking what it means to support the whole employee.
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.
The Trump administration has issued a series of executive orders aimed at recalibrating federal oversight of employer-sponsored health plans. These directives target unpublished rules and agency enforcement priorities, signaling a shift toward deregulation and increased flexibility for plan sponsors.
Once considered a niche offering or a reactive add-on, mental health benefits have now moved to the center of the employee experience. In 2025, nearly half of U.S. employers offer some form of mental health support beyond traditional EAPs—a sharp rise from just 30% in 2023. This shift isn’t just cultural; it’s strategic.
As Q4 begins, benefits managers face a trio of compliance developments with implications for plan design, documentation, and year-end filings. Two are federal in scope, while one local ordinance continues to affect employers nationwide.
As the final quarter of 2025 begins, several developments in benefits administration are reshaping how employers manage compliance, coverage, and communications. From rebate distribution rules to state-level legislation, benefits managers should take note of key updates that may affect plan operations and documentation heading into year-end.
