Weekly Health Compliance Briefing

February 11, 2026

While we do our best to provide timely updates, it is possible that the information shared in the newsletter may change after our publication deadline.

Health Notes

 

HHS Announces ACA Cost-Sharing Limit for 2027
The Department of Health and Human Services (HHS) has issued a memo announcing the maximum annual limitations on cost-sharing for the 2027 benefit year for non-grandfathered group health plans under the Affordable Care Act (ACA). The memo announces that the maximum annual limit on cost-sharing for 2027 will increase to $12,000 for self-only coverage and $24,000 for other than self-only coverage (for reference, the 2026 limits are $10,600 and $21,200, respectively). In general, cost-sharing includes deductibles, coinsurance, copayments, and any other required expenditure that is a qualified medical expense with respect to essential health benefits covered under the plan. In the past, HHS announced the annual limitations on cost-sharing in the notice of benefit and payment parameters, but the limitations (and several others) are currently published in a memo by January of the preceding benefit year, provided that no changes to the methods for calculating these amounts are proposed.

HHS Announces Inflation Adjustments for Civil Monetary Penalties for HIPAA, MSP, and SBC Violations
HHS has announced adjustments to civil monetary penalties for statutes within its jurisdiction and are based on a cost-of-living increase of 1.02598%. These adjustments are effective for penalties assessed on or after January 28, 2026, for violations occurring on or after November 2, 2015. The adjustments potentially impacting employer-sponsored health plans are:

(i) HIPAA. HIPAA administrative simplification encompasses standards for privacy, security, breach notification, and electronic health care transactions. HIPAA has four tiers of violations that reflect increasing levels of culpability, with minimum and maximum penalty amounts within each tier and an annual cap on penalties for multiple violations of an identical provision. The indexed penalty amounts for each violation of a HIPAA administrative simplification provision are as follows:

(a)  Tier 1: Lack of Knowledge. The minimum penalty is $145 (up from $141); the maximum penalty is $73,011 (up from $71,162); and the calendar-year cap is $2,190,294 (up from $2,134,831).

(b)  Tier 2: Reasonable Cause and Not Willful Neglect. The minimum penalty is $1,461 (up from $1,424); the maximum penalty is $73,011 (up from $71,162); and the calendar-year cap is $2,190,294 (up from $2,134,831).

(c)  Tier 3: Willful Neglect, Corrected Within 30 Days. The minimum penalty is $14,602 (up from $14,232); the maximum penalty is $73,011 (up from $71,162); and the calendar-year cap is $2,190,294 (up from $2,134,831).

(d)  Tier 4: Willful Neglect, Not Corrected Within 30 Days. The minimum penalty is $73,011 (up from $71,162); the maximum penalty is $2,190,294 (up from $2,134,831); and the calendar-year cap is $2,190,294 (up from $2,134,831).

(ii) Medicare Secondary Payer (MSP). The MSP statute prohibits a group health plan from “taking into account” the Medicare entitlement of a current employee or a current employee’s spouse or family member and imposes penalties for violations. The indexed amounts for violations applicable to employer-sponsored health plans are as follows: (a) offering incentives to Medicare-eligible individuals not to enroll in a plan that would otherwise be primary: $11,823 (up from $11,524); and (b) failure of responsible reporting entities to provide information identifying situations where the group health plan is primary: $1,512 (up from $1,474).

(iii) Summary of Benefits and Coverage (SBC). An SBC must be provided to participants and beneficiaries before enrollment or re-enrollment in a group health plan. The penalty for a health insurer’s or non-federal governmental health plan’s willful failure to provide an SBC is $1,443 (up from $1,406) for each failure.

Aon Publications

 

Congress Passes Legislation Implementing PBM Reform
On February 3, 2026, Congress passed legislation that includes certain reforms related to pharmacy benefit management (PBM) services reporting and compensation disclosures. President Trump signed the bill into law on the same day. Under the law, PBMs are required to provide detailed information to group health plans on drug prices and spending, design restrictions, and compensation paid or received by the PBM. Group health plans also are required to provide plan participants with a summary of this information upon request. 

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