Plan Compliance
BAC ensures your benefit plans are supported by accurate, compliant documentation that’s easy to understand and legally sound. This includes the official Plan Document, which outlines the terms and conditions of your self-funded health plan. We also prepare the Summary of Benefits and Coverage (SBC), which provides a standardized, side-by-side comparison of what’s covered and what members can expect in terms of cost-sharing. For employers offering multiple benefits, we create Wrap Documents to bundle medical, dental, vision, and other plans into a single ERISA-compliant structure. In addition, we support Section 125 Cafeteria Plans, allowing employees to pay for eligible benefits with pre-tax dollars. Our team ensures that all documents are up to date, fully compliant with federal regulations, and ready to support both plan sponsors and participants.
As your TPA, BAC supports the preparation and distribution of required annual notices and reports to help keep your self-funded health plan compliant. This includes assistance with Form 5500 filings, Summary Annual Reports (SARs), HIPAA and CHIPRA notices, Women’s Health and Cancer Rights Act (WHCRA) disclosures, and the Medicare Part D Creditable Coverage Notice. We ensure these important communications are completed accurately and delivered on time—helping you meet your obligations as a plan sponsor and keeping your employees informed.
RxDC Reporting (Pharmacy Benefit and Drug Costs Reporting) is federally required reporting emanating from Section 204 of the Consolidated Appropriations Act (CAA) 2021. The goal of the reporting requirement is to understand prescription drug costs and their impact on escalating health care costs in America. Per the CMS Newsroom on November 17, 2021, we will expect to see “…biennial public reports on prescription drug pricing trends and the impact of prescription drug costs on premiums and out-of-pocket costs starting in 2023. These reports are expected to enhance transparency and shed light on how prescription drugs contribute to the growth of health care spending and the cost of health coverage.”
The deadline to submit data for the prior calendar year is June 1st. BAC, in partnership with your Pharmacy Benefit Manager (PBM), coordinates to ensure all filing components are uploaded timely to CMS via the HIOS portal.
Gag Clause Attestation is another requirement by the Consolidated Appropriations Act of 2021 (CAA). The first GCPCA was due Dec. 31, 2023, with subsequent attestations being due by Decemebr 31 of each year thereafter.
A “gag clause” is a contractual provision that prevents certain parties from discussing specific information. Gag clauses have been used by some entities to prevent healthcare providers from disclosing certain price related information. BAC works to confirm all contracts are clear of gag causes so that we can complete the attestation requirement on behalf of our Plans.
As your TPA, BAC helps make sure your health plan complies with the Mental Health Parity and Addiction Equity Act (MHPAEA) by reviewing plan design and claims processing practices to confirm mental health and substance use disorder benefits are offered at parity with medical/surgical benefits. With increased federal enforcement and stricter documentation requirements, we assist plan sponsors in preparing comparative analyses of Non-Quantitative Treatment Limitations (NQTLs) and addressing any compliance gaps—helping reduce audit risk and support plan integrity.
The No Surprises Act (NSA), enacted as part of the Consolidated Appropriations Act (CAA) of 2021, was designed to protect patients from unexpected and often costly medical bills—commonly known as surprise bills. These situations typically arise when individuals receive care from out-of-network providers in circumstances where they have little or no control over who treats them—such as during emergencies or while receiving services at an in-network facility (e.g., an out-of-network anesthesiologist at an in-network hospital).
At BAC, we have long prioritized member protection by paying these claims at in-network rates when possible and negotiating directly with providers to prevent balance billing. With the implementation of the NSA, BAC adapted our out-of-network claims handling to ensure full compliance with the new law. This includes using the Qualifying Payment Amount (QPA)—a benchmark rate established under NSA regulations that can be used in the Independent Dispute Resolution (IDR) process, if necessary.
In addition to addressing payment standards, the NSA also introduced new transparency requirements, including the need to display out-of-pocket cost information on member ID cards. BAC has incorporated these updates to help ensure your plan and its members remain protected and informed under the new legal standards.
The Transparency in Coverage Rule, issued under the ACA, requires group health plans to publicly share healthcare pricing information to help members make informed decisions and encourage cost competition.
Machine Readable Files (MRFs) BAC posts required pricing data for self-funded plans at https://bactpa.com/find-providers.html. Just click the “$” icon under your network logo to view your plan’s pricing data, provided directly by the network. While these files are complex, we continue working with network partners to improve access and update this information monthly.
Online Price Comparison Tool: Since January 1, 2023, plans must offer a digital tool showing real-time costs for common services, expanding to all covered services in 2024. BAC members can access this by logging into the BAC Member’s Area and clicking “Shop for Care” in the left menu. This will connect you to our transparency partner, Mpowered Health, where you can search services or providers and see estimated out-of-pocket costs based on your plan. We continue to enhance this tool for better usability and value.
BAC plays a key role in helping your self-funded health plan comply with the Affordable Care Act (ACA). We monitor ongoing regulatory changes and ensure your plan adheres to core ACA provisions—most notably, coverage of preventive services without cost-sharing, which is subject to frequent updates. BAC supports the enforcement of dependent coverage up to age 26 and helps ensure that eligibility rules, enrollment timelines, and benefit structures are aligned with federal requirements. We also assist employers by sharing data related to all members on the health plan that is needed to complete 1095-C reporting.
For self-funded health plans, the Patient-Centered Outcomes Research Institute (PCORI) fee is an annual requirement under the Affordable Care Act. As your TPA, BAC will prepare the IRS Form 720 (Excise Tax Return) with the applicable PCORI fee calculated for your plan year and forward it to your team for review, payment, and submission. While we’re here to support the process, BAC cannot submit the form or make the payment on behalf of the plan sponsor. The PCORI fee is due by July 31st each year.