Compliance & Coverage Clarifier: Gag Clauses and Contraceptive Rules
As year-end compliance tasks ramp up, two areas of regulatory scrutiny deserve closer attention: gag clause attestations and recent changes to contraceptive coverage exemptions.
What Counts as a Gag Clause?
Under the Consolidated Appropriations Act, employer-sponsored health plans must attest by December 31, 2025 that they do not include “gag clauses” in contracts with third-party administrators or provider networks. But what exactly qualifies?
A gag clause is any provision that restricts access to or disclosure of:
- Provider-specific cost or quality data
- De-identified claims information
- Network composition or reimbursement terms
Common examples include language that prohibits sharing negotiated rates with plan participants or blocks access to benchmarking tools. Plans must ensure that contracts allow transparency and data sharing, especially for price comparison platforms and reporting requirements.
Fully insured and self-funded plans are subject to this rule. Employers should review service agreements and confirm that carriers or TPAs will submit the attestation on their behalf—or prepare to file directly via the CMS portal.
Who’s Affected by the Contraceptive Coverage Ruling?
A recent federal court decision vacated a key exemption that allowed employers to opt out of contraceptive coverage based on religious or moral objections. While the ruling may be appealed, it currently affects:
- Religious institutions
- Closely held corporations
- Employers with grandfathered plans
Organizations that previously relied on this exemption should reassess their plan design and consult legal counsel. Updates to Summary Plan Descriptions (SPDs) and employee communications may be required to reflect new coverage obligations.
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Compliance & Coverage Clarifier: Gag Clauses and Contraceptive Rules
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