10/29/2025

Employers that sponsor self-funded health benefit plans are required to submit a Gag Clause Prohibition Compliance Attestation (GCPCA) by Dec. 31, 2025, to the federal government. Plans administered by Star Marketing and Administration, Inc., comply with the provision established by the Consolidated Appropriations Act, 2021, and can download this confirmation of compliance, which can be used as supportive documentation for their attestation.

Employers with questions about the attestation or the GCPCA can contact their Client Manager.

What is the GCPCA? 
The provision prohibits plans from entering into an agreement with a healthcare provider, network or association of providers, third-party administrator (TPA) or other service provider offering access to a network of providers that would restrict the plan from accessing and sharing certain information.

The U.S. Department of Health and Human Services (HHS) is collecting the attestations on behalf of the Department of Labor, HHS and the Treasury.

What are employer requirements? 
The Centers for Medicare & Medicaid Services (CMS) requires employers to complete the attestation via a webform. To log in, you need a unique code that you’ll receive after clicking on the "Don't have a code or forgot yours?" button. Enter your email address and click  "Get my unique code." A GCPCA Responsible Entity Excel Template (XLSX) (may 2024, version 6) is also available to submit.

Either way, the attestation requests:

• Name of the reporting entity
• Employer Identification Number (EIN)
• If applicable, the three-digit plan number that you reported you reported on IRS Form 5500
• Reporting entity type
• Mailing address for the reporting entity
• Phone number for reporting entity point-of-contact
• Types of provider agreements addressed in the attestation

This attestation will be required annually.

Confirmation of Compliance Available 
Employers with plans administered by Star Marketing and Administration, Inc., can download this confirmation of compliance, which can be used as supportive documentation for their attestation.

For more information, check out these documents from CMS: 

• Frequently Asked Questions (PDF)
• Instructions for submitting the GCPCA (PDF) (version 6.01)
• User Manual for submitting the GCPCA (PDF) (version 10.0)
• GCPCA Responsible Entity Excel Template (XLSX) (May 2024, version 6)

9/30/2025

Starting January 1, 2026, Medicare Part D will cap annual out-of-pocket prescription drug costs at $2,100 (up from the $2,000 cap set for 2025).¹

Why It Matters:
This change could cause some employer-sponsored prescription drug plans that were previously “creditable” to now be classified as non-creditable. Creditable coverage means your plan’s prescription drug benefits are expected to pay, on average, as much or more than Medicare Part D.

Reminder:
Employers must notify Medicare-eligible employees every year whether their prescription coverage is creditable or not. If notices aren’t sent, employees could face penalties for late Medicare Part D enrollment—and employers risk compliance issues.
 
What You Need to Do:
If you offer a group health plan administered by Star Marketing and Administration, Inc.:

1. Log in at TrustmarkSB.com/login
2. Open your Administration Kit
3. Use the 2026 Medicare Calculator to check your plan’s creditable status
4. Review results now to confirm compliance and send notices before Oct. 15, 2025, if required

• Notify all Medicare-eligible members 60 days prior to the plan start date
• Provide CMS required notices
• Understand that failure to act may result in penalties and compliance exposure

A non-grandfathered group health plan’s in-network out-of-pocket maximum for essential health benefits (EHBs) for the 2026 plan year cannot exceed $10,600 for self-only coverage and $21,200 for other-than self-only coverage.

The in-network out-of-pocket maximum applies to all individuals, regardless of whether an individual has a self-only plan or other-than single coverage. Self-funded group health plans are not required to cover EHBs. But, if they do, they cannot impose lifetime or annual dollar limits on those benefits.

For high-deductible health plans (HDHPs) for the 2026 plan year, the out-of-pocket limit will be $8,500 for self-only coverage and $17,000 for other-than self-only coverage. The minimum deductible is changing to $1,700 for self-only coverage and $3,400 for other-than self-only coverage.