The Consolidated Appropriations Act and transparency rules reshaped health plan fiduciary duty — broker compensation, gag clauses, RxDC, machine-readable files, and parity analyses.
Since December 2021, brokers and consultants expecting $1,000 or more in compensation for services to ERISA group health plans must disclose their direct and indirect compensation in writing before the contract is signed or renewed. Fiduciaries must use it to assess fee reasonableness.
Read the full answerHealth plans may no longer agree to contract terms that block access to provider-specific cost or quality data, or restrict sharing claims data — "gag clauses." Plans must attest compliance to CMS annually by December 31, and the attestation duty sits with the plan even when vendors file it.
Read the full answerRxDC (prescription drug data collection) reporting requires group health plans to submit detailed prescription drug and healthcare spending data to CMS annually by June 1 for the prior calendar year. Carriers and PBMs usually file most sections, but employers must supply plan-level data and confirm the filing.
Read the full answerThe Transparency in Coverage rules require health plans to publicly post machine-readable files disclosing in-network negotiated rates and out-of-network allowed amounts, updated monthly. Carriers and TPAs build the files, but employers must ensure a public link exists — commonly on their website.
Read the full answerHealth plans imposing nonquantitative treatment limitations — like prior authorization or network standards — on mental health or substance use benefits must maintain a written comparative analysis proving those limits are applied no more stringently than for medical benefits, available to regulators on request.
Read the full answerPut these answers to work
Fiduciary In A Box walks your team through every one of these requirements step by step — documenting decisions, organizing files, and keeping your plan compliant year-round.
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