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.

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.