Regulatory updates to watch in Q4
These are the health care regulations, announcements and changes to keep on your radar for Q4 2025.
Staying on top of the legislative changes in an industry as complex and highly regulated as health care can be challenging. That’s why UnitedHealthcare is committed to easing that burden and keeping employers as well as brokers and consultants updated on the legislative changes as they arise.
Here are 4 notices and actions to watch in Q4:
Gag Clause Confirmation of Compliance
UnitedHealthcare has made available for self-funded employers a Confirmation of Compliance, indicating that UnitedHealthcare completed its annual review to support Gag Clause Prohibition Compliance Attestation (GCPCA).
Self-funded customers may use the UHC, Surest, UMR or HealthSCOPE Confirmation of Compliance to support their attestation for any UnitedHealthcare administered medical, behavioral and pharmacy business.
Self-funded customers who would like UnitedHealthcare to submit the attestation for them should discuss this with their UnitedHealthcare representative. It will require signing a Letter of Direction and providing some information. It is important that customers notify UHC of their intention and have the appropriate paperwork submitted by the November 1 deadline.
UnitedHealthcare attests for fully insured and level funded groups.
UnitedHealthcare is compliant with the Consolidated Appropriations Act (CAA) Gag Clause, which prohibits health plan sponsors and health insurance issuers, such as UnitedHealthcare, from entering into agreements with health care providers, networks or associations of providers, third-party administrators or other service providers offering access to a network of providers that prevent the disclosure of certain quality and cost of care information.
Anticipated timing: The attestation is required by Dec. 31, 2025
Who it impacts: Fully insured, level funded and self-funded employers
Telehealth Deductible Waiver for High Deductible Health Plans/Health Savings Accounts
The July 4, 2025, H.R. 1 One Big Beautiful Bill Act (OBBBA) includes the Permanent Extension of Safe Harbor for Absence of Deductible for Telehealth Services in Sub Chapter C, Section 71306.
Self-funded customers
- Self-funded customers may choose to cover Virtual Care Services (aka 24/7 Virtual Urgent Care via National Providers – currently Teladoc, Amwell and Doctor On Demand). Customers may choose to simply waive the deductible and pay at plan benefits or may choose to cover the benefits at no cost-share.
- Customers may also choose to waive the deductible for the Telehealth "brick and mortar" services though the member’s primary or specialty provider.
- To allow for adequate time to implement changes, we encourage employers to make the change on their renewal. Retro changes are not supported due to complexity, volume of claim reprocessing and impact of health savings account (HSA) on the members.
Fully insured customers
A standard fully insured plan is in the works.
- Fully insured large group standard plans – availability for large groups 51+ new and renewing on and after July 1, 2026. (California and New York 100+)
- Fully insured small group standard plans – available for small groups 2 to 50 new and renewals on and after Jan. 1, 2027.
- AON private exchange groups – available beginning Jan. 1, 2026.
- Non-standard fully insured large group 100+ plans may include Virtual Urgent Care as they renew, beginning now.
- Mid-year changes are not acceptable.
Anticipated timing: Available now
Who it impacts: Optional for self-funded customers with HDHPs
Expanded Preventive for self-funded groups with High-Deductible Health Plan
Based on guidance in IRS Section 2024-75, self-funded customers with a high-deductible health plan (HDHP) may choose to adopt certain items at zero cost-share prior to the deductible. This initiative aims to enhance preventive care and support improved access to affordable services for members.
This offering is exclusive to large self-funded plans and does not apply to fully insured plans. Benefits are available for medical, pharmacy or both.
- Coverage for over-the-counter oral contraceptives including emergency contraceptives and male condoms
- Covered whether they are purchased with a prescription
- If no prescription, the claim may require payment and then be submitted for reimbursement
- Coverage for continuous glucose monitors for individuals diagnosed with diabetes
- Select insulin products. For example: devices used to administer or deliver the selected insulin.
Anticipated timing: Optional on renewal
Who it impacts: Large self-funded employers
ACA Preventive Services for Breast Cancer Screening
As of Jan. 1, 2026, UnitedHealthcare’s Medical Policy will include additional breast cancer screenings 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) will be updated on January 1.
Anticipated timing: Jan. 1, 2026
Who it impacts: Fully insured, Level Funded and self-funded plans
4 additional items we’re watching closely
- Changes from the administration based on their Request for Information (RFI) requesting where regulations could be simplified
- Guidance for the pharmacy requirement under the Transparency Rule for Machine Readable Files
- ACA guidance on accessibility and CAA guidance on air ambulance reporting
- CAA guidance on Advanced Cost Estimate
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