What Employers Need to Know

• The total annual medical premium amounts paid by you, the plan sponsor, on behalf of participants and beneficiaries in calendar-year 2023.
• The total annual medical premium amounts paid by participants and beneficiaries in calendar-year 2023 (that is, separate from the medical premium amounts paid by you as the plan sponsor).

We have created an FAQ to help answer any questions you may have.

You can also find additional information specific to this reporting requirement is here: https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/prescription-drug-data-collection#:~:text=Under%20Section%20204%20(of%20Title,is%20called%20the%20RxDC%20report

What is the Gag Clause Prohibition?
Pursuant to the Consolidated Appropriations Act of 2021 (CAA), group health plans are prohibited from entering into an agreement with a health care provider, network, association of providers, or third-party administrators (TPA) that would restrict: 1) provider specific cost or quality information sharing with plan members or; 2) a plan participant, beneficiary or enrollee from electronically accessing de-identified claims information.

What is the Gag Clause Attestation?
Pursuant to the CAA, plans and issuers must submit an annual attestation of compliance with the CAA Gag Clause. The attestation, or Gag Clause Prohibition Compliance Attestation (GCPCA), must be submitted every year and no later than December 31 of each calendar year. The first GCPCA is due by December 31, 2023.

What Actions Are Required by Nippon’s Fully-Insured Medical Customers?
No action is required by our customers, or their representatives, to attest to their plan’s compliance.
For questions, please contact your broker, consultant or a Nippon Life Benefits representative.