Regulatory updates to watch in Q1

On Dec. 19, UnitedHealthcare submitted its gag clause attestation to the Centers for Medicare and Medicaid Services (CMS) as required under the Consolidated Appropriations Act (CAA). UnitedHealthcare attestation applied to fully insured, Level Funded and self-funded customers that signed a letter of direction and provided the necessary data. The gag clause attestation submission confirmation Submission ID is 105125.

This attestation confirms that contracts do not include gag clauses that restrict access to price or quality information.

Note: Self-funded customers who did not request UnitedHealthcare to attest have a Confirmation of Compliance from UnitedHealthcare to support their own attestation submission.

Anticipated timing: Dec. 19, 2025

Who it impacts: All fully insured and Level Funded customers and all self-funded customers who signed a letter of direction and provided the necessary data.

Under the CAA, health insurers offering group or individual health coverage, and self-funded group health plans, are required to report data annually regarding prescription drugs and health care spending to the Departments of Health and Human Services, Labor, and Treasury (Tri-Agencies), as part of the Prescription Drug Data Collection (RxDC).

To support customers with this important filing, UnitedHealthcare will be submitting the required data for business administered by UnitedHealthcare for all employers who had active coverage during the 2025 reference year. However, similar to last year, completion of the submission requires gathering some information not currently maintained in our system using a request for information (UHC RFI) in the employer/broker portal.

Anticipated timing:

• Feb. 1, 2026 — RFI tool is available to employers (or their brokers or consultants) via the web portal set up by CMS.
• Feb. 3, 2026 — Employers, brokers and consultants should receive an email from UnitedHealthcare with the RxDC information by this date; otherwise, reach out to your UnitedHealthcare representative if you have not received the email, which begins mailing Jan. 28.
• March 31, 2026 — Deadline to enter the requested data.
• June 1, 2026 — Required submission date to report 2025 data.

Who it impacts: Fully insured, Level Funded and self-funded employers

UnitedHealthcare is required to provide 1095-B forms for fully insured groups. The 1095-B form supports the Affordable Care Act (ACA) requirement for groups to offer minimum essential coverage (MEC). It is also a requirement for the Individual Mandate states which require all residents to have health insurance.

Anticipated timing:

• January 2026 — 1095-B forms will be posted on UnitedHealthcare member portals (e.g., myuhc.com®) for fully insured subscribers ahead of the March 2026 deadline. Resident subscribers in states with the Individual Mandate (California, Washington, D.C., New Jersey and Rhode Island) will have forms mailed unless the member has requested paperless communications.
• By March 31, 2026 — UnitedHealthcare will submit the 1095-B via the 1094 transmittal form to the Internal Revenue Service (IRS) and to the Individual Mandate states (California, Washington, D.C., New Jersey and Rhode Island) by their state required deadlines.

Who it impacts: Fully insured groups

The employer is required to submit the 1095-C for fully insured groups with 50+ full-time employees (FTEs) and self-funded groups. The 1095-C form supports the ACA employer mandate and confirms the group offered a plan with MEC, minimum value (MV) and a plan that is affordable, as defined under the ACA.

It’s critical to note that creating the 1095-C and submitting via the 1094-C transmittal form is the responsibility of the employer — not UnitedHealthcare. If a customer does not submit the 1095-C (with the 1094-C transmittal form) and the customer is audited, there are penalties.

Anticipated timing:

• March 2, 2026 - Fully insured groups with 50 or more FTEs and self-funded groups must furnish the subscribers a 1095-C form by this federal deadline.
• March 31, 2026 – They must submit the 1095-C with the 1094-C to the IRS by this deadline and to the tax revenue departments for the Individual Mandate states by their required deadlines. 

Who it impacts: Fully insured groups with 50 or more FTEs and self-funded groups

As of Jan. 1, 2026, UnitedHealthcare’s Preventive Care Services Medical Policy will include additional breast cancer imaging with no out-of-pocket costs. Health Resources and Services Administration (HRSA) made the following recommendations, which will be included in the January 1 medical policy for plans that cover ACA preventive care services:

• Breast cancer screening for women of average risk includes the following where indicated: additional imaging such as MRI, ultrasound and mammography (including 3D mammography), as well as pathology evaluation (including breast biopsy)

The UnitedHealthcare Preventive Care Services Medical Policy (formerly Preventive CDG) has been updated.

Anticipated timing: Jan. 1, 2026

Who it impacts: Fully insured, Level Funded and self-funded plans