Benefits compliance rarely changes all at once. It shifts through a steady stream of indexed limits, new reporting obligations, delayed rules, and legislation that quietly alters what plan documents must say. Heading into 2027, there is more movement than usual. Some of it isroutine, some of it is new, and some of it is unsettled. Employers who sort those three buckets early will head into open enrollment and the new plan year with far fewer surprises.
Start With the Numbers That Reset on January 1
Every plan year, the IRS and HHS adjust a set of dollar figures, and 2027 brings a few notable jumps. The ACA affordability percentage for employer coverage rises to 10.22 percent, the first time it has crossed 10 percent. That gives larger employers a little more room when setting employee contributions for the lowest-cost, minimum value, self-only option. It does not change the underlying mandate. Employers still need to offer affordable, minimum value coverage to full-time employees and their dependents, and they still need to test affordability using one of the safe harbors and report accurately on Forms 1094-C and 1095-C.
The out-of-pocket maximum for non-grandfathered plans also climbs sharply, to $12,000 for self-only coverage and $24,000 for family coverage. A jump that size can catch a plan off guard if cost-sharing was built around last year’s ceiling. Medical and pharmacy cost sharing both count toward that limit, so it is worth confirming with your carrier or administrator that every plan option, including any carved-out pharmacy benefit, stays under the cap. Employers with high deductible health plans paired with HSAs should also confirm that deductibles and out-of-pocket limits fit the 2027 HDHP rules, and that payroll and benefits vendors have updated HSA contribution limits before the first January paycheck. The limit for an excepted benefit HRA also increases to $2,250.
These changes also have a communication side. Any plan design change for 2027 should be reflected in an updated Summary Plan Description or a Summary of Material Modifications, and the open enrollment window is the natural time to get those notices in front of employees.
Plan Documents Need to Catch Up With 2025 Legislation
The One Big Beautiful Bill Act made several changes to benefits that took effect in 2026, and many employers are only now discovering that their plan documents have not caught up. The dependent care FSA limit increased to $7,500, which can create nondiscrimination testing problems for plans that already struggled to pass. The telehealth safe harbor for HDHPs was made permanent, so first-dollar telehealth no longer threatens HSA eligibility. Direct primary care arrangements can now coexist with an HSA within set monthly limits. Employer student loan payments under an educational assistance program were made permanent as well, and beginning in 2027 the annual cap on educational assistance will be indexed for inflation.
Most of these provisions are optional, which is exactly why they get overlooked. An employer that wants to take advantage of a higher dependent care limit or add telehealth first-dollar coverage must amend the plan and tell participants. Amendments adopted late, or not at all, are one of the more avoidable compliance gaps in a plan audit.
Prescription Drug Transparency and Fiduciary Responsibility
Health plan fiduciary duty is getting more attention, and pharmacy benefits are at the center of it. Plans of every size and funding type must file the annual prescription drug data collection report by June 1. Even though a carrier or administrator often files on the plan’s behalf, the legal responsibility sits with the plan, so employers should confirm in writing who is filing what and keep that confirmation on record.
Pharmacy benefit managers now carry a disclosure obligation of their own as well. The Consolidated Appropriations Act of 2026 requires PBMs to provide compensation disclosures to ERISA group health plan sponsors, and that requirement took effect in February 2026. When a plan sponsor expects a PBM or PBM consultant to receive $1,000 or more in direct or indirect compensation, the sponsor must request an ERISA 408(b)(2) compensation disclosure before signing, renewing, or extending the contract. The sponsor must then review it to determine whether the compensation is reasonable. The stakes are real. Fiduciaries who enter into a prohibited transaction can face civil penalties, lawsuits from plan participants, and personal liability for overpayments tied to unreasonable compensation and any profits improperly earned.
Some PBMs may say they are not ready or are waiting for guidance or a model form. That does not change the plan sponsor’s responsibility to make the request. The Department of Labor is currently enforcing the requirement on a good faith basis, which makes documentation especially important. Keep a record of when the request was made and how the PBM responded and treat every PBM renewal or extension as a trigger to repeat the process.
On top of that, the Department of Labor has proposed more detailed disclosure rules for pharmacy benefit managers. For calendar year plans, the proposal would take effect with the plan year beginning in January 2027, though employers should confirm its final status with their advisor. The direction is clear either way. Plan sponsors are expected to see what their PBM is doing, contracts should not block the information a plan needs for oversight, and the process used to select and monitor vendors should be documented. Health and welfare plans are increasingly being treated like retirement plans, with formal committees, meeting minutes, and periodic vendor reviews. Employers who already have a disciplined monitoring process will find it easier to adapt.
Existing obligations still apply too. Broker and consultant compensation disclosures, the annual gag clause prohibition attestation, and price transparency requirements have not gone away. They simply need a place on the compliance calendar so they are completed on time every year.
Mental Health Parity: Unsettled, but Not Optional
Mental health parity is the least settled area on this list. The federal agencies announced in 2025 that they would not enforce the new provisions of the 2024 final rule while they reconsider it and litigation continues, and enforcement has since been narrowed toward a few priority areas. It would be a mistake to read that as permission to relax. The underlying parity law and the earlier 2013 rule remain in effect, and plans are still expected to be able to produce a comparative analysis showing that limits on mental health and substance use disorder benefits, such as prior authorization, network design, and visit caps, are no more restrictive than those applied to medical and surgical benefits.
The practical move is to keep that analysis current and ask carriers and third-party administrators for their documentation now, rather than waiting for a request from regulators. Congress has bipartisan interest in strengthening enforcement, and the political landscape after the November elections could change the pace. A plan with its paperwork already in order will not need to scramble if the rules tighten again.
Build a Calendar, Not a Scramble
None of these issues is difficult on its own. The trouble comes from timing. Open enrollment materials, plan amendments, vendor confirmations, and annual filings all converge in the last quarter and the first few weeks of the plan year, and the work is easy to push aside when everyone is busy with enrollment questions.
A better approach is to work backward from January 1. Confirm affordability and out-of-pocket limits against the new numbers. Review every plan document against the 2025 legislation and decide which optional changes to adopt. Get written clarity from each vendor on who files what and when**, and request PBM compensation disclosures ahead of any renewal**. Refresh the parity analysis. Then lay out the filings and notices for the full year in one place so nothing depends on memory.
Compliance work done early costs a few conversations. Done late, it can mean corrected filings, penalties, and uncomfortable explanations to employees. Employers who sit down with their benefits advisor now will enter 2027 with a plan that is accurate, documented, and ready for whatever the regulators decide next.
