Navigate the CAA Gag Clause: UnitedHealthcare's Role and Your Responsibility


The CAA mandates an annual submission of the Gag Clause Prohibition Compliance Attestation (GCPCA). UnitedHealthcare is set to handle the attestation process for its fully insured clientele. However, those in the Level Funded and self-funded categories will receive a confirmation of compliance from UnitedHealthcare, which is intended to bolster their own attestation efforts. The deadline for these attestations is set for December 31, 2023.

In terms of applicability, the requirements of the gag clause prohibition are comprehensive. They are relevant to all health insurance providers and group plan sponsors involved in various insurance frameworks, from fully insured setups to Level Funded and self-funded scenarios. This extends to a plethora of health plans, spanning from ERISA plans to student health initiatives. However, accepted benefits are exempted from this requirement.

For self-funded clients, proactive action is a must. They are obligated to present a GCPCA on an annual basis to corroborate their adherence to the gag clause prohibition. The initial attestation, which is due on or before December 31, 2023, encompasses the timeframe starting from December 27, 2020, to the attestation date. Each subsequent attestation will cover the period since the previous one and will also have a December 31 yearly deadline. The HHS has laid down a dedicated web portal, coupled with a set of guidelines for the attestation submissions.

In situations where customers or plan sponsors have unique agreements, such as CSP/GSP or carve-outs like OptumRx Direct, they bear the responsibility of coordinating with external organizations to present the relevant attestation.

UnitedHealthcare's Strategy:

  1. Fully insured: UnitedHealthcare will submit the necessary attestation to the HHS portal. Customers don't need to make any further attestations for their fully insured dealings with UnitedHealthcare.

  2. Level Funded and self-funded: The responsibility of submitting the attestation doesn't fall on UnitedHealthcare. Instead, UnitedHealthcare will furnish a compliance confirmation, aiding customers in their attestation submissions to the HHS portal.

Communication Approach: UnitedHealthcare will make the compliance confirmation accessible by the conclusion of Q3 each year. This confirmation will be disseminated via the Connect news, and will also feature in the news segment of once it's available. Clients can also acquire this confirmation from their UnitedHealthcare account team. In mixed funded scenarios, UnitedHealthcare will only cater to the fully insured plans, leaving the self-funded plans' attestation to the customer. UMR and Surest will adopt a similar approach to UnitedHealthcare.

For any further clarifications, individuals are encouraged to get in touch with their broker, consultant, or a UnitedHealthcare representative. Additional resources include the Consolidated Appropriations Act FAQs, specifically the Gap Clause section, and detailed instructions for submitting the GCPCA.

UHC's article and official statement can be found here.