Employers offering group health plans have flexibility in defining eligibility but must comply with several legal requirements to avoid penalties. The document outlines key “Do’s” and “Don’ts” to help employers properly manage health plan eligibility.

This document discusses how certain state insurance laws may conflict with federal Health Savings Account (HSA) eligibility requirements. Some states mandate that health insurers count third-party payments (e.g., drug manufacturer discounts, coupons, or vouchers) toward an enrollee’s out-of-pocket expenses. However, to maintain HSA eligibility, federal rules require that only actual expenses paid by the insured individual count toward the deductible.

If your business qualifies as an Applicable Large Employer (ALE)—meaning you have 50 or more full-time or full-time equivalent employees—you have specific reporting requirements under the Affordable Care Act (ACA). These reporting obligations ensure compliance with IRS Code Sections 6055 and 6056, which track employer-sponsored health coverage.

Navigating health plan compliance is critical for employers in 2025. Key updates include simplified ACA reporting, new mental health parity requirements, stricter HIPAA standards, and changes to telemedicine exceptions for HSA plans. Employers must also adapt to evolving state pharmacy benefit manager regulations. Staying informed and proactive is essential to maintaining compliance and supporting employee benefits.

The Safety Advisory Committee is committed to ensuring a safe and healthy workplace within the Safety Group. As part of this commitment, we have attached our semi-monthly safety flyer handouts on Lifting/safe lifting techniques for your employees. Please review the detailed safety procedures document attached to this email and ensure you understand your role in maintaining a safe workplace.