Navigating Health Plan Compliance Developments for 2026
Employers should stay alert to several important compliance developments that will shape the design and administration of health plans in 2026. Notably, in 2026, many organizations subject to the Affordable Care Act’s (ACA) reporting requirement will first use the streamlined approach for distributing individual statements. In addition, a number of anticipated regulatory shifts warrant close attention, including potential revisions to federal mental health parity standards and additional flexibility in offering fertility benefits.
As 2026 begins, the compliance environment remains somewhat unsettled due to new regulatory priorities under the Trump administration, ongoing benefits-related litigation and changes in federal staffing. This year, federal agencies will be working to implement the One Big Beautiful Bill Act (OBBBA) while also prioritizing President Donald Trump’s broader directives, such as expanding health care transparency.
Key Developments
- Simplified ACA reporting for employers who notify employees of their right to receive an individual statement upon request
- Expanded HSA eligibility for individuals with first-dollar telehealth coverage or memberships in DPC arrangements
- Updates to HIPAA Privacy Notices for Part 2 program records
- More lawsuits regarding fiduciary compliance for group health plans
Other Possible Charges
- Additional health care transparency requirements
- New guidance regarding mental health parity compliance
- Additional flexibility for offering fertility benefits outside of group health plan coverage
- Stricter HIPAA cybersecurity protections
Expanded Access to HSAs
On July 4, 2025, a sweeping tax and spending bill, commonly referred to as the OBBBA, was signed into law. Although significantly pared down from its original draft version, the OBBBA includes a broad set of changes for employee benefit plans, most of which take effect in 2026. These changes expand options for existing employee benefit plans and present new benefit-related opportunities for employers to consider for 2026. Significantly, the OBBBA expands access to health savings accounts (HSAs), tax-advantaged medical savings accounts generally available to individuals who are enrolled in high deductible health plans (HDHPs) and do not have other health coverage.
The OBBBA permanently allows employers with HDHPs to provide benefits for telehealth and other remote care services before plan deductibles have been met without jeopardizing HSA eligibility. A pandemic-related relief measure temporarily allowed HDHPs to waive the deductible for telehealth services without impacting HSA eligibility; however, this bipartisan-supported relief expired at the end of the 2024 plan year. The OBBBA retroactively extended this relief, effective for plan years beginning after Jan. 1, 2025, and made it permanent. Employers with HDHPs should review their health plan’s coverage of telehealth services and assess if changes should be made, considering the OBBBA’s permanent extension. Any changes to telehealth coverage should be communicated to plan participants.
Effective Jan. 1, 2026, the OBBBA further expands access to HSAs by allowing individuals with direct primary care (DPC) arrangements to make HSA contributions if their monthly fees are $150 or less ($300 or less for family coverage). These dollar limits will be adjusted for inflation each year. A DPC arrangement is a subscription-based health care delivery model where an individual is charged a fixed periodic fee for access to medical care consisting solely of primary care services. In addition, the OBBBA treats DPC fees as a medical care expense that can be paid for using HSA funds. Given this change, employers with HDHPs may wish to explore integrating DPC arrangements into their benefits packages.
Simplified ACA Reporting
At the end of 2024, Congress passed legislation that eased ACA reporting requirements for employers. The ACA requires applicable large employers (ALEs) and non-ALEs with self-insured health plans to provide information to the IRS about the health plan coverage they offer (or do not offer) to their employees while providing related statements to individuals. Yet, with the new legislation, employers that take certain steps no longer need to automatically distribute these individual statements, unless an individual specifically requests one. In late February 2025, the IRS released guidance on this relief, leaving employers only a brief period to apply the change for statements due in March 2025. Because of the limited time frame, many employers are expected to begin using this relief starting in 2026.
For this relief to apply in 2026, an employer must post a clear and conspicuous notice on its website by March 2, 2026, stating that employees may receive a copy of their statement upon request. The notice must include an email address, a physical address to which a request may be sent, and a telephone number to contact the employer. This website notice must remain posted through Oct. 15, 2026. In general, employers must fulfill requests within 30 days of receiving them.
Crossroads for Mental Health Parity Rules
In May 2025, federal agencies announced they would not enforce a 2024 final rule that expanded parity requirements for mental health and substance use disorder (MH/SUD) benefits. This decision stems from a lawsuit filed by an employer trade group challenging the rule’s validity. The case has been put on hold while the Trump administration reviews the rule and considers whether to revise or repeal it. Many of the final rule’s provisions were originally set to take effect in 2026. At the same time, the Trump administration is taking a broader look at its overall approach to enforcing mental health parity.