Increased Civil Penalty Amounts for Certain Violations

Effective November 15, 2021, the U.S. Department of Health and Human Services (HHS) has increased the following key penalties affecting group health plans:

Summary of Benefits and Coverage (SBC): up to $1,190 per participant or beneficiary.

Medicare Secondary Payer (MSP): up to $9,753.

HIPAA privacy and security rules: Penalties depend on the type of violation involved, and are broken down into “tiers” that reflect increasing levels of knowledge of the violation, as follows:

  • Tier one: Minimum $120, maximum $60,226, annual cap $1,806,757

  • Tier two: Minimum $1,205, maximum $60,226, annual cap $1,806,757

  • Tier three: Minimum $12,045, maximum $60,226, annual cap $1,806,757

  • Tier four: Minimum $60,226, maximum and annual cap $1,806,757

Employers should become familiar with the new penalty amounts and review their benefit plan administration protocols to ensure full compliance.

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