| Compliance Considerations | Fully Insured | Self-Funded |
|---|---|---|
| Transparency in Coverage (included in the Consolidated Appropriations act of 2021) | Plans should confirm insurer compliance. | Plans must comply with the No Surprises Act, preventing surprise medical bills for emergency and non-emergency services and air ambulance services. Disclosure notices must be provided to enrolled individuals. |
| Plans should confirm insurer compliance. | Plans must prepare and publish to a public website machine-readable in-network and out-of-network allowed amounts with detailed pricing information. Plans may enter into a contract with a third party to maintain the public disclosures. | |
| Plans should confirm insurer compliance. | Plans must report annually on pharmacy benefits and drug costs. | |
| Plans should confirm insurer compliance. | Plans must make a pharmacy benefit and drug cost price comparison tool available for the first 500 shoppable items and services beginning the first day of the plan year in 2023 with the remaining items and services included in 2024. | |
| Plans should confirm insurer compliance. | Plans must prepare mental health parity comparative analysis disclosures. | |
| Health Insurance Portability and Accountability Act of 1996 (HIPPA) Privacy and Security | Plans have few requirements. | Plans are considered covered entities under HIPAA regulations and must have all applicable policies and procedures in place. |
| 105(H) Nondiscrimination Rules | Plans are not subject to certain nondiscrimination rules. | Plans should perform nondiscrimination testing annually. |
| Plans may be subject to applicable state laws regarding severance packages. |
Certain prohibitions on COBRA subsidies for highly compensated individuals when included in severance packages or nonprotected leaves of absence. |
|
| COBRA Continuation of Coverage | Small plans, not subject to federal COBRA, must comply with any state mini-COBRA laws. |
Small plans, not subject to federal COBRA, are not subject to state mini-COBRA laws. |
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