Gag Clause Attestation Guide
September 7, 2023
Employer-sponsored group health plans (both self-funded and fully insured) are prohibited from entering into agreements with a health care provider, network or association of providers, third-party administrator, or other service provider where the plan is restricted from accessing and sharing certain information. Employer-sponsored group health plans are also required to submit an annual attestation that the plan is in compliance with these requirements. The due date for attestations is December 31, 2023. Below is a chart outlining carrier positions on Gag Clause Attestations.
Additional information regarding the Gag Clause Prohibition requirements can be found on the CMS website. On this site, plan sponsors can find Frequently Asked Questions, detailed instructions for submitting the attestations, a link to the reporting template, and a link directly to the web form for submission.
| Aetna | Based on recent market intelligence and feedback from our broker/consultant community, we have reassessed our approach for the Gag Clause Prohibition Compliance Attestation (GCPCA): Aetna will submit the GCPCA on behalf of all fully-insured plan sponsors including small group and middle market AFA plan sponsors. As previously decided, Aetna will not submit the GCPCA template on behalf of our self-funded plan sponsors. Plan sponsors must submit their attestation through the web form that the Centers for Medicare and Medicaid Services (CMS) has created. |
| AmeriHealth/ AmeriHealth Administrators | AmeriHealth and AmeriHealth Administrators will submit the attestation for fully insured and self-funded customers by the required date from CMS. Data will not be provided to the customers directly. AmeriHealth Administrators will post a Market Edge article notifying the customers that the attestation was completed. |
|---|---|
| Anthem | Anthem is telling fully insured clients that Anthem will file the Gag Clause Prohibition Compliance Attestation on their behalf by the December 31, 2023, deadline. There is no action required of them. (Also applies to Small Group MEWA, ABF, Minimum Premium, and FEHP.) |
| Capital | Capital is preparing to submit attestations of compliance on behalf of fully-insured groups. Additionally, ASO groups may elect to have Capital submit attestations on the group’s behalf. We will share more details on this option in the near future. |
| Cigna | For fully insured clients:
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| HealthNow (HNAS) | HealthNow Administrative Services hereby confirms that the administrative services provided to clients are consistent with the requirements set forth in the Consolidated Appropriations Act, 2021, Section 201: INCREASING TRANSPARENCY BY REMOVING GAG CLAUSES ON PRICE AND QUALITY INFORMATION. |
| Highmark | Fully-Insured Clients:
Administrative Services Only (ASO) Clients:
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| Horizon (NJ) | Fully Insured Group Plans: Horizon will attest on the Department of Health and Human Services (HHS) website on behalf of its fully insured groups, as required. No action is required by the customer to attest for their fully insured business with Horizon. This is applicable to both medical and behavioral health coverage. Group health plan sponsors Prime Therapeutics (Prime): In agreement with Prime Therapeutics, our Pharmacy Benefits Manager, Horizon will also share Prime’s Certificate of Compliance on our website by the end of Q3 2023, and each year thereafter. This is only applicable to groups who have pharmacy coverage with Horizon. |
| Imagine360 | Imagine360 will be submitting an attestation on behalf of all clients that are active as of the date of the submission. Our submission is limited to any direct provider contracts with Imagine360 (or affiliates) and contracts between Imagine360 and our clients. This includes any providers our health plan clients may access through a network agreement or third-party agreement (e.g. PBM) that is held by Imagine360 (or affiliates). If a health plan maintains any other direct contracts, it must submit its own attestation for those specific agreements. |
| Independence Blue Cross / Independence Administrators | Independence Blue Cross and Independence Administrators will submit the attestation for insured and self-funded customers by the required date from CMS. Data will not be provided to the customers directly. Independence will post an Edge article notifying the customers that the attestation was completed. |
| Trustmark | Employers that sponsor self-funded health benefit plans are required to submit a Gag Clause Prohibition Compliance Attestation (GCPCA) by Dec. 31, 2023, to the federal government. Plans administered by Star Marketing and Administration, Inc., comply with the provision established by the Consolidated Appropriations Act, 2021. 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. |
| United Healthcare | Fully insured:
Level Funded and self-funded groups:
Communications strategy:
Mixed funded:
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