Plan sponsors of group health plans are required to attest annually that any contracts between the group health plan(s) and its service providers are free of prohibited gag clauses.

Attestations for 2025 can be completed any time up until December 31st.

A gag clause is contractual language that contains any of the following:

• restrictions on the disclosure of provider-specific cost or quality of care information or data to referring providers, the plan sponsor, participants, beneficiaries, or enrollees;
• restrictions on electronic access to de-identified claims and encounter information or data for each participant, beneficiary, or enrollee (consistent with the privacy regulations included in the Health Insurance Portability and Accountability Act (HIPAA), the Genetic Information Nondiscrimination Act (GINA), and the Americans with Disabilities Act (ADA); and
• restrictions on sharing information or data described in (1) and (2) with a business associate (as defined by HIPAA privacy regulations).

Carriers will generally handle the attestation on behalf of fully insured group health plans.  Service providers (e.g., Third Party Administrators and Pharmacy Benefit Managers) may handle the attestation on behalf of self-funded/level funded group health plans, but otherwise the employer is responsible to attest.

Resources

• Amwins Connect Compliance Library (including a Carrier chart listing their participation with the submission)
• Amwins Connect Gag Clause Attestation Guide
• Download the Gag Clause Attestation Employer Letter from the Amwins Connect website
• CMS Detailed Definitions and Information on Gag Clause Compliance
• Department of Labor Gag Clause Attestation Annual Submission Webform Instructions

^{While every effort has been taken in compiling this information to ensure that its contents are totally accurate, neither the publisher nor the author can accept liability for any inaccuracies or changed circumstances of any information herein or for the consequences of any reliance placed upon it. This publication is distributed on the understanding that the publisher is not engaged in rendering legal, accounting, or other professional advice or services. Readers should always seek professional advice before entering into any commitments.}