ICHRA Affordability - Updated Premium Look-Up Table

The affordability of an ICHRA is tied to the lowest cost silver plan available on the public Exchange/Marketplace. The rates vary based on an employee’s worksite or residence, so CMS publishes premium data via a Look-Up Table for Federally-facilitated Exchanges and State-based Exchanges using the Federal Platform. Employers can use this information to help determine affordability for their ICHRA offering. Plan year data for 2019 – 2026 can be found here.

Trump Accounts - IRS Guidance

IRS Notice 2025-68 announces the IRS’s intent to issue proposed regulations implementing Trump Accounts (TAs)—a new type of IRA added under the One Big Beautiful Bill Act (OBBBA) that may be established for eligible minors. The notice provides some initial guidance on how these accounts will operate. Beginning July 4, 2026, employers may contribute up to $2,500 per year (indexed annually) per employee on a tax-favored basis via Trump Account Contribution Plans (TACPs). The notice also confirms that TACPs may be offered through cafeteria plan salary reductions, and that further rules coordinating TACPs with cafeteria plans will be addressed in upcoming proposed regulations. The notice can be found here. 

Reminder - Gag Clause Attestation Due Soon

CMS sent out a reminder email for gag clause attestations, which are due annually by December 31. The reminder provides a short set of FAQs for the annual attestation requirement. It also describes the minor changes made to the attestation form and process for 2025. You can find the email here.

Carriers generally handle attestation for fully insured group health plans. Service providers (e.g., TPAs and PBMs) may handle the attestation on behalf of self-funded group health plans, but otherwise, the employer is responsible for attesting. For employers looking for a vendor to handle the attestation, see Lumelight’s solution here.

CMS Final Rule – Hospital Pricing Transparency

CMS’s recent final rule aims to strengthen hospital price transparency requirements beginning in 2026. Hospitals must publicly disclose actual (rather than estimated) allowed amounts along with counts and National Provider Identifiers (NPIs) in machine-readable files (MRFs), backed by a formal accuracy attestation. While this could certainly increase price transparency, the required MRFs remain highly technical and difficult for the average consumer to interpret. As a result, employers and third-party tools will play a critical role in translating these data into usable insights for plan members. That being said, more accurate, transparent pricing data may give employer-sponsored group health plans stronger leverage in evaluating hospital contracting and benchmarking provider prices. Employers might also use the information to enhance benefit design strategies such as tiered networks, reference pricing, and steering toward lower-cost care settings. The fact sheet for the final rule can be found here.

Guidance for Electronic Submission of ACA Employer Reporting

The IRS has released Publication 5164 and 5165 for the 2025 filing season, providing updated guidance for electronic submission of Forms 1094 and 1095 through the AIR system. While the publications outline technical standards and testing procedures, most employers will continue to rely on third-party vendors for electronic reporting due to the complexity of obtaining a Transmitter Control Code (TCC), meeting formatting specifications, and completing required testing. Employers should confirm they are prepared to electronically file or have a vendor solution in place ahead of the 2025 reporting deadlines. The publications can be found here – Publication 5164 (Rev. 10-2025) and here.

For information about Lumelight’s ACA Employer Reporting solutions, see here.

Kaiser Family Foundation (KFF) Survey  

The 2025 KFF Employer Health Benefits Survey underscores the continued rise in employer-sponsored health costs, with family premiums climbing 6% to nearly $27,000 this year. Employees are contributing roughly $6,850 on average toward that total, reflecting the sustained pressure both workers and employers face in managing healthcare expenses. Beyond premiums, cost-sharing burdens continue to climb. The average deductible for single coverage rose to $1,886, with employees at smaller firms facing substantially higher out-of-pocket costs.

Employers cite escalating prescription drug prices—especially for new therapies and weight-loss medications—as a major factor behind rising costs. Chronic disease and hospital costs are also significant drivers. In response, employers are increasingly exploring new care models to improve value and manage costs: nearly a third of firms with 50 or more workers now contract for virtual primary-care services, and some are forming direct arrangements with provider groups.

You can find extensive detail from KFF’s survey here.

CMS Marketplace Fact Sheet

While we wait to see whether enhanced advanced premium tax credits, which are set to expire at the end of 2025, will make it into the budget bill currently being negotiated by Congress to end the government shutdown, CMS released a fact sheet outlining its expectations for the 2026 Marketplace plan year. The fact sheet highlights efforts to preserve consumer choice, stabilize premiums, and expand access to HSA–eligible plans. You can find the fact sheet here. 

FAQs – Fertility Coverage Options

Recent agency FAQs clarify that employers may offer fertility-related benefits (e.g., in-vitro fertilization) as an excepted benefit, provided the coverage is offered under a separate, fully-insured policy and is not coordinated with another group health plan maintained by the same plan sponsor. The benefit would be treated similarly to a specified disease or fixed indemnity policy. Because excepted benefits are exempt from many ACA coverage mandates, they do not need to be integrated with the employer’s major medical plan and do not affect HSA eligibility.

The FAQs further explain that fertility benefits meeting the requirements of §213(d) may also be reimbursed through an Excepted Benefit Health Reimbursement Arrangement (EBHRA). An EBHRA may be offered to employees who are eligible for—though not necessarily enrolled in—the employer’s major medical plan, with annual reimbursement limited to $2,200 for 2026.

Outside of an EBHRA, employers currently cannot offer a stand-alone, self-funded reimbursement arrangement for fertility benefits that would qualify as an excepted benefit. However, the agencies have indicated an intent to pursue rulemaking that could expand how fertility benefits may qualify as “limited excepted benefits,” potentially allowing self-funded options in the future.

The FAQs can be found here.

Employer Plan Sponsor Responsibilities

A federal court in Minnesota (Orrison v. Mayo Clinic) allowed claims to proceed that the plan and its administrator failed to disclose out-of-network reimbursement methodology (a breach of its ERISA fiduciary duties) and failed to maintain an accurate provider directory (a violation of the No Surprises Act/Transparency requirements). This provides a reminder for employers (as plan sponsors) to work with carriers, TPAs, and other vendors to maintain accurate provider directories for participants and ensure plan documents and participant materials clearly explain cost-sharing calculations—especially how allowed amounts for out-of-network services are determined. The court decision can be found here.

2025 Final Form 1094-C & Form 1095-C

The IRS has released the final 2025 Forms 1094-C and 1095-C with no changes from how they looked in 2024. We’re still waiting on the 2025 accompanying instructions, but we don’t anticipate changes there either, so employers can begin preparing now for the upcoming ACA employer reporting season. The forms can be found here.

IRS 2025-2026 Priority Guidance Plan

The IRS released its 2025–2026 Priority Guidance Plan, which outlines the agency’s intended areas of focus for the coming year. For employer-sponsored health and welfare benefits, there are no real surprises in the plan—most of the items listed are routine updates, such as the annual release of cost-of-living adjustments, Health Savings Account (HSA) limits, and the Patient-Centered Outcomes Research Institute (PCORI) fee notice. While no major new initiatives affecting health and welfare plan design are included, the plan does provide a helpful indication of when employers can expect the IRS to issue these regular updates. You can find the plan here.

HIPAA Security Risk Assessment Tool Updated

Employers sponsoring group health plans that are covered entities under HIPAA are required to conduct a security risk analysis for electronic protected health information (ePHI). Employers can use the Security Risk Assessment (SRA) Tool created by the Department of Health & Human Services Office for Civil Rights (OCR) to assist with this analysis. The tool guides organizations in identifying where ePHI is stored or transmitted, evaluating vulnerabilities, and documenting risks with corresponding mitigation steps. The latest version (v3.6) enhances usability with clearer guidance, updated questions and responses that reflect current cybersecurity practices, and improved educational content addressing areas such as encryption and incident response. The latest version of the SRA Tool can be found here.

In addition, find more information about Lumelight’s HIPAA solutions here.