One important aspect in healthcare benefits is Gag Clause Compliance, which is essential for understanding your healthcare coverage. Let’s break down what Gag Clause Compliance means for you and your employer-sponsored health plan.

Understanding Gag Clause Compliance:

Gag Clause Compliance enhances transparency in your health plan and provides employers with comprehensive insights into the quality and pricing structures of their plans. It ensures that your employer can access all the necessary information about your healthcare costs and quality information. The Department of Labor is enforcing the Consolidated Appropriations Act (CAA), which includes the Gag Clause. Employers need unrestricted access to claims data to gain a comprehensive understanding of healthcare quality and pricing within their plans. The Gag Clause prohibits contractual provisions that limit access within employer-sponsored health plans.

Key Points to Consider:
  • Gag Clause Prohibition Compliance Attestation (GCPCA):
Plan sponsors and issuers are required to submit an annual GCPCA to confirm their compliance with the Gag Clause prohibition.
  • Employer Responsibilities:
If the answer to the attestation is NO (indicating limited access to claims data), it is the employer's responsibility to terminate the contract with the non-compliant party. The employer must ensure unrestricted access to claims data.
  • Self-Funded Employers and Delegation:
Self-funded employers can delegate GCPCA reporting responsibilities to a Third Party Administrator (TPA). However, it's crucial to note that the plan sponsor remains legally responsible for compliance. Written agreements detailing the delegation should be maintained in records.
  • What Ethos Benefits Clients Can Expect:
For Ethos Benefits clients, rest assured that we have reviewed the Gag Clause Compliance requirements on your behalf. You will receive a notice containing specific instructions tailored to your plan setup, ensuring seamless compliance with this regulation.

Unveiling Transparency: No Behind the Scenes

Gag Clause Compliance is about making sure your health plan is clear and open. By understanding the nuances of this regulation, employers can make informed decisions, foster compliance, and provide their employees with comprehensive and transparent healthcare benefits. With this knowledge, you can feel confident that your employer is looking out for your best interests when it comes to your healthcare coverage.

Stay informed and empower your organization with knowledge. If you have any questions, your employer or Ethos Benefits is there to help!

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