Gag Clause Compliance for Group Health Plans Overview

On November 4, 2025

Federal regulations bar group health plans and health insurers from entering into agreements that restrict access to specific data regarding provider pricing or service quality. These contractual limitations—known as “gag clauses”—can prevent plans from sharing or obtaining vital cost and care information. To ensure compliance, plans and insurers must file an annual attestation with the […]

On November 3, 2025

Medical Mutual is in active negotiations with Licking Memorial Health System (LMHS), which includes Licking Memorial Hospital and Licking Memorial Professional Providers, to address their high reimbursement rate structure.

On October 28, 2025

Employer health plans usually allow employees to enroll their spouses. However, when a spouse has access to their own employer coverage, some organizations impose additional conditions to manage overall medical plan spending. These strategies generally fall into two buckets: Employers may also try positive incentives, such as cash opt-out credits or a special type of HRA, […]

On October 28, 2025

Pharmacy Benefit Changes, MedMutual Employer Lunch and Learns, 2026 Small Group ACA Marketing Materials, Updates to MyParamount Portal

On October 21, 2025

The United States Department of Labor, United States Department of Health and Human Services, and United States Department of the Treasury have issued new guidance clarifying how employers can use excepted benefits to offer or expand fertility coverage. This action follows Executive Order 14216, which directed the Domestic Policy Council to develop strategies to improve access to in vitro […]

On October 20, 2025

Medical Mutual is negotiating with ProMedica Health System regarding network status for the 2026 plan year.

On October 14, 2025

On October 9, 2025, the IRS released Revenue Procedure 2025-32 (Rev. Proc. 25-32), which includes the 2026 inflation-adjusted limit on employee salary reduction contributions to health flexible spending accounts (FSAs). For plan years beginning in 2026, the adjusted dollar limit on employees’ pre-tax contributions to health FSAs increases to $3,400. This is a $100 increase from the 2025 […]

On October 14, 2025

Medical Mutual, MHS, Paramount Sending Annual Creditable Coverage Letters, Introducing MedMutual Simple Life and Gag Clause Reporting Responsibilities Reminder

On October 7, 2025

As of Wednesday, October 1, the federal government has entered a shutdown that will remain in effect until further notice. This has significantly impacted the Employee Benefits Security Administration (EBSA), a division of the U.S. Department of Labor (DOL) responsible for enforcing regulations related to health and retirement benefits. According to the DOL, roughly 504 […]

On October 1, 2025

In June 2025, the Internal Revenue Service (IRS) released draft 2025 forms for Affordable Care Act (ACA) reporting under Internal Revenue Code Sections 6055 and 6056. Thereafter, on September 17, 2025, draft instructions for the C series forms were released; however, the IRS has not yet released draft instructions for the B series forms. No […]

News & Updates

Gag Clause Compliance for Group Health Plans Overview

MMO: 11/3/25 Special Broker Update

Strategies for Limiting Spousal Participation on Group Health Plans

MMO: 10/28/25 Broker Update

New Federal Guidance Expands Options for Employer-Sponsored Fertility Benefits

MMO: 10/20/25 Special Broker Update

IRS Releases Health FSA Limits for 2026

MMO: 10/14/25 Broker Update

Government Shutdown Halts Many EBSA Operations, Delays Likely for Employers

Still Waiting for the IRS to Issue Final Versions of Forms 1094/1095-B/C