CAA Gag Clause Prohibition Compliance Attestation required by Dec. 31, 2023

The CAA Prohibition on Gag Clauses provision requires an annual Gag Clause Prohibition Compliance Attestation (GCPCA). UnitedHealthcare will make the attestation for fully insured customers as required. For Level Funded and self-funded (ASO) customers, UnitedHealthcare will provide a confirmation of compliance to support the customer’s responsibility to complete their own attestation. Attestations are required by Dec. 31, 2023.

Requirements and scope

The gag clause prohibition and attestation requirements apply broadly to all health insurance issuers and group plan sponsors offering fully insured, Level Funded or self-funded (ASO) coverage in the group and individual markets, including grandfathered and transitional relief plans, student health plans, individual coverage offered through an association, ERISA plans, non-federal governmental plans, and church plans. Accepted benefits are not included in the requirement.

Self-funded customers – action needed

Self-funded group health plans and health insurance issuers offering coverage in the individual and group markets must submit a GCPCA annually to confirm that the plan or issuer is complying with the gag clause prohibition.

The first attestation – due no later than Dec. 31, 2023 – covers the period beginning Dec. 27, 2020, through the date of the attestation.

Each subsequent attestation covers the period since the preceding attestation and will be due Dec. 31 of each year.

HHS has established a web portal and instructions for submitting the attestations.

External Customer arrangements

Customers/plan sponsors with special arrangements such as CSP/GSP and carve outs including OptumRx Direct are responsible for working with outside entities to submit a corresponding attestation.

Summary – UnitedHealthcare approach

  • Fully insured:  UnitedHealthcare will make the attestation to the HHS portal as required. No action is required by the customer to attest for their fully insured business with UnitedHealthcare.
  • Level Funded and self-funded groups:  UnitedHealthcare does not submit the attestation. UnitedHealthcare will provide a confirmation of compliance, which the customer may use to support its own attestation submission to the HHS portal.

    Communications strategy

    • The confirmation of compliance will be available by end of Q3 each year
    • This confirmation will go out via the Connect news and be posted in the news section of wh­­en it is available
    • The confirmation will also be available from your UnitedHealthcare account team
  • Mixed funded: UnitedHealthcare will submit the attestation for fully insured plans. The customer will need to complete the attestation for the self-funded plans.
  • UMR and Surest will follow the UnitedHealthcare approach.

For questions, please contact your broker, consultant or UnitedHealthcare representative. 

Consolidated Appropriations Act FAQs (refer to Gap Clause section).

Instructions for submitting the GCPCA

More updates for your clients

New releases, updates and notifications for a broad spectrum of UnitedHealthcare products and services.

Important, required notices for products, plans, forms and more.

Need-to-know operational announcements for you and your clients.