The deadlines do not send reminders. We do.
Most benefits compliance failures are not decisions. They are dates that passed while somebody was busy. Almost all of them run off your plan year rather than the calendar, which is exactly why they get missed. Below is what a plan year actually obliges you to do, and which of it we carry.
Stated as rules, because that is how they are written.
Each deadline below is expressed the way the regulation expresses it — relative to your plan year — with the calendar-year plan date in brackets. Which ones apply depends on your size and funding model.
Form 5500
Last day of the seventh month after your plan year ends. [Calendar-year plan: 31 July.] A Form 5558 extension buys up to two and a half months more [15 October], but it has to be filed on or before the original due date.
ERISA welfare plans. Exempt if fewer than 100 participants at the start of the plan year and unfunded, fully insured, or a combination. Funded through a trust and you file at any size.
Summary Annual Report
Within nine months after the plan year closes [30 September]. If the 5500 was extended, within two months after the extension period ends [15 December].
Not required if the plan is exempt from filing the 5500. Totally unfunded welfare plans are exempt.
Furnishing Forms 1095-C
31 January, plus a permanent automatic 30-day extension — so about 2 March. No further extension exists. See “What changed” below: you may now be able to post a notice instead of mailing.
Applicable large employers. Always calendar-year based — this one never follows your plan year.
Filing 1094-C and 1095-C
28 February on paper, 31 March electronically (next business day if that falls on a weekend or holiday).
Electronic filing is mandatory once you file 10 or more information returns in aggregate — W-2s, 1099s and 1095s counted together. In practice that is nearly every applicable large employer.
Part D notice to employees
Annually, before 15 October — ahead of Medicare’s annual enrollment window. Also at initial eligibility, at the coverage effective date, on any change in creditable status, and on request.
Any employer offering prescription drug coverage. A fixed calendar date, not a plan-year one.
Part D disclosure to CMS
Within 60 days after your plan year begins, within 30 days of terminating drug coverage, and within 30 days of any change in creditable status.
Filed online with CMS. This one does run off your plan year, which is why it is the more commonly missed of the two.
PCORI fee, Form 720
31 July of the calendar year following the last day of your plan year. A plan year ending 31 January 2026 is therefore not due until 31 July 2027.
Sponsors of self-insured plans, including level-funded plans and most HRAs. If you are fully insured the carrier pays it — but a fully insured plan with an HRA alongside means you owe it on the HRA.
Summary of Benefits and Coverage
No later than 30 days before the first day of the new plan year at renewal. With enrollment materials otherwise, within 90 days for special enrollees, and within seven business days on request.
A mid-year material change not already reflected in the SBC needs notice at least 60 days before it takes effect.
CHIP notice
Annually, to employees in states that offer Medicaid or CHIP premium assistance — whether or not they are enrolled in your plan.
The regulation says only “annually”; the practical answer is to send it with open enrollment materials so it has a fixed home in the year.
RxDC prescription drug reporting
1 June each year, covering the previous calendar year. Plan-level spending on prescription drugs and on medical claims, filed to CMS through the Health Insurance Oversight System.
Group health plans of every size, insured and self-funded. Your carrier, TPA or PBM files most of the data. The plan-level file is the one that gets missed, because nobody else can produce it.
Gag clause attestation
31 December each year. An attestation that nothing in your contracts with a network, a TPA or a provider stops you from seeing your own claims and cost data.
Group health plans of every size, insured and self-funded. A carrier or TPA may submit for you. Get that in writing — the attestation is the plan’s obligation, not theirs.
Rules hold still. Numbers do not.
These are the current figures. Where the 2027 number is already published we have put it alongside, because most of the renewals being quoted right now straddle both years.
ACA affordability
9.96% of household income. The most an employee can be asked to pay for self-only coverage before your offer stops counting as affordable. For plan years beginning in 2027 it rises to 10.22%.
Price against a safe harbor you can actually see — W-2, rate of pay or federal poverty line — not household income you will never know.
Employer mandate penalties
$3,340 and $5,010 per full-time employee, per year. The first if you offer nothing to substantially all full-time employees. The second if the offer is unaffordable or fails minimum value.
The first counts every full-time employee less the first thirty. The second counts only the ones who took a subsidy on the Marketplace.
ACA out-of-pocket maximum
$10,600 self-only, $21,200 family. The ceiling on in-network cost sharing for essential health benefits. For 2027: $12,000 and $24,000.
This is not the HDHP limit below, and the two are not interchangeable. A plan can clear one and fail the other.
HDHP limits
$1,700 and $3,400 minimum deductible. $8,500 and $17,000 maximum out-of-pocket. What a plan has to look like before an HSA is allowed to sit next to it.
Self-only first, family second. Embedded deductibles are where family plans usually break the test.
HSA contributions
$4,400 self-only, $8,750 family, plus the $1,000 catch-up from age 55.
Catch-up is per accountholder. A couple both over 55 need two accounts to use both.
Health FSA
$3,400, with up to $680 carrying into the next year.
Carryover and a grace period are alternatives, not a pair. A general-purpose carryover also blocks HSA eligibility into the following year.
PCORI fee
$3.84 per covered life for plan years ending between 1 October 2025 and 30 September 2026. The band before it was $3.47.
Self-funded and level-funded plans pay it themselves on Form 720. On a fully insured plan the carrier pays it and you do not file.
Excepted-benefit HRA
$2,200 for the plan year. The standalone account you can fund for someone who declines your plan.
Useful where a spouse’s plan is the better buy and you still want to put money behind the employee.
Half of this list does not apply to you.
Employer headcount is what switches most of these obligations on, and the thresholds do not line up neatly. Here is roughly where each band sits.
Below the mandate, not below the rules
Under 50 full-time and full-time-equivalent employees you are not an applicable large employer — no employer mandate and no 1094-C or 1095-C filing. Federal COBRA begins at 20 employees — the same threshold in every state. Michigan has no state continuation law behind it, so a Michigan employer under 20 has no continuation obligation at all. ERISA plan documents, SBCs, and the Part D and CHIP notices apply from your very first plan, at any size.
The year you cross fifty is the year it changes
Crossing 50 full-time equivalents makes you an applicable large employer: the employer mandate and 1094-C/1095-C reporting begin, measured on the prior calendar year — so the obligation arrives a year after the growth did. Form 5500 follows once the plan reaches 100 participants — counted as covered employees, not dependents.
Self-funding brings its own filings
At this size self-funding becomes the common answer — including level funded, which is self-funded up to the attachment point however much the invoice looks like a premium. It carries obligations a fully insured employer never sees: the PCORI fee on Form 720, owed by you rather than the carrier, and Section 105(h) non-discrimination testing on the plan. Multi-site payrolls also start to complicate eligibility data.
More vendors, more documents
Carve-outs mean several arrangements, each with its own plan document, disclosures and reporting. Populations spread across states pick up state leave and continuation rules that do not follow your head office, and fiduciary process stops being informal.
The filing most employers assume does not apply to them.
Every ERISA welfare plan is in scope unless it qualifies for the small-plan exemption. Two things decide it, and the second one is where the language gets confusing.
Do you have to file?
You are exempt only if both are true: fewer than 100 participants at the start of the plan year, and benefits paid from the employer’s general assets or through an insurance contract rather than through a trust.
Miss either condition and you file, at any headcount.
“Funded” does not mean what it usually means
In everyday benefits language a plan is fully insured or self-funded. ERISA uses the word differently: a plan is “funded” when its assets sit in a trust.
So a fully insured plan and a self-funded plan paid from general assets are both unfunded for this test — and both can use the exemption. Put a trust in place and the exemption disappears regardless of size.
Level funded counts as self-funded. The invoice arrives looking like a fully insured premium, but the employer is funding claims up to an attachment point with stop-loss above it — which is why level-funded plans get classified wrongly more often than any other kind.
Who counts as a participant
Covered employees, not their dependents. A plan covering 80 employees and 140 dependents is at 80, not 220.
Count it at the start of the plan year. Crossing 100 mid-year does not pull you in until the following year.
When it is due
Last day of the seventh month after the plan year ends [calendar-year plan: 31 July]. Form 5558 extends it by up to two and a half months [15 October], but it has to be filed on or before the original due date — you cannot extend retroactively.
The SAR follows it
A Summary Annual Report goes to participants within nine months of the plan year closing [30 September], or two months after the extension period ends if you extended [15 December].
No 5500 obligation means no SAR obligation.
If you are already late
Penalties on a delinquent 5500 accrue per day, per filing, with no natural ceiling — which is what makes an old missed filing expensive rather than merely awkward.
The DOL runs a Delinquent Filer Voluntary Compliance Program for exactly this: file late voluntarily, before you are contacted, and the penalty is capped at a fraction of the exposure.
Six clocks, and they start without you.
COBRA failures are almost never a decision someone made. They are a day count that ran out.
General notice
Within 90 days of coverage beginning.
Employer to administrator
30 days after the qualifying event.
Administrator to the individual
14 days after being notified — or 44 days from the event where you are your own administrator, which most employers are.
Election period
At least 60 days, running from the later of the notice date or the date coverage would be lost.
First premium
At least 45 days after the election. Every payment after that gets a 30-day grace period.
Individual-triggered events
Divorce, a child aging off, a disability determination — the individual has 60 days to tell the plan.
Four things moved this year. Two of them can cost you.
Your plan may have stopped being creditable
CMS revised the arithmetic behind Medicare Part D creditable coverage. The old simplified method asked whether the plan was expected to pay 60% of prescription drug costs. The revised one asks for 72%. Nothing about your benefits has to change for the answer to flip.
For 2026 a group plan that does not claim the retiree drug subsidy may use either method. Re-test before the October notice goes out. Sending a creditable notice for a plan that is not creditable hands an employee a Part D late enrollment penalty they had no way to see coming.
Wellness rules loosened, and in your favor
On 26 August 2026 Labor, HHS and Treasury issued new wellness guidance. If an employee meets a reasonable alternative standard partway through the plan year, you may start the reward from that point forward instead of backdating it to January.
The same guidance draws a line on disclosure. The alternative-standard notice belongs in every material that describes the program’s terms. It does not have to appear in one that merely mentions the program exists.
Parity enforcement is paused. Parity is not.
The Departments are not enforcing what was new in the 2024 mental health parity rule while they reconsider it through rulemaking. That relief reaches only the new provisions. The 2013 rule still stands.
What did not move: the 2021 statutory duty to produce a written comparative analysis of every non-quantitative treatment limitation, on request. Fully insured or self-funded, it is the plan’s document to hand over. Anyone describing parity as suspended is reading the headline rather than the statement.
HSAs got easier to pair
Bronze and catastrophic-level plans became HSA-compatible on 1 January 2026 without having to meet the deductible test, direct primary care arrangements no longer block eligibility, and the telehealth-before-deductible safe harbor is permanent rather than a temporary extension.
If a plan design was ruled out of an HSA strategy at a prior renewal on any of those three grounds, the ruling is stale. It is worth re-pricing.
You may not have to mail 1095-Cs any more
The Paperwork Burden Reduction Act moved furnishing to an on-request model. Instead of mailing every employee a 1095-C, you can post a clear and conspicuous notice on your website saying a copy is available on request.
The conditions matter: the notice goes up by the furnishing deadline, stays up through 15 October, and a requested copy goes out within 30 days. Several states — California, New Jersey, Rhode Island, Massachusetts and DC among them — run their own furnishing mandates that this federal relief does not switch off.
Non-discrimination testing is less settled than it looks
The timing everyone quotes for Section 125 testing comes from proposed regulations issued in 2007 that were never finalized. It is established practice rather than settled law.
What follows from that is practical, not academic: run a projection mid-year and the real test as of the last day of the plan year, because a Section 125 failure generally cannot be corrected once the year has closed.
Compliance is a service here, not a disclaimer.
We track the dates
Your account manager holds the compliance calendar for your plan year, so the reminder arrives before the deadline rather than after it.
We prepare the filings
ACA reporting, ERISA documents and the annual disclosures — prepared and reviewed, not handed back to you as a checklist.
We bring in the specialist
CPAs and ERISA attorneys are available through the firm when a question runs past what a licensed insurance broker should answer alone.
Rules move. So does your headcount.
When you cross a threshold
Fifty employees changes your obligations materially, and it is easy to cross without noticing. We watch the count rather than waiting for you to report it.
When you cross a state line
State leave, continuation and reporting rules do not follow your head office. With benefits expertise across 26 states, a distributed workforce does not mean a second broker.
Sourced from the agencies that write the rules: the U.S. Department of Labor for ERISA — Form 5500, the SAR, COBRA notices and participant disclosures; the Internal Revenue Service for the tax-code side — ACA employer reporting, the PCORI fee and non-discrimination testing; and CMS for Medicare Part D creditable coverage. General information, not legal or tax advice: which rules apply to your plan depends on its size, funding and documents. CFH Insurance Consultants are licensed insurance brokers; CPAs and ERISA attorneys are available through the firm.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents — two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
An independent employee benefits consulting firm. We look at the entire benefits program — cost, plan performance, risk and administration.
Bloomfield Hills, MI 48304
248.370.8853
719.425.2649
281.404.5670
Cookies on this site
We use cookies to keep the site working properly and to understand how it is used. You can decline anything that is not essential. See our Privacy Policy for the detail.
- Essential — needed for the site to load and for you to move around it. These cannot be switched off.
- Analytics — tell us which pages get read, so we know what is worth writing more of.
- Advertising — set by third parties such as ad and social platforms to measure and target campaigns.