Illinois Employer Medical Coverage Model Disclosure Update

The Illinois Consumer Coverage Disclosure Act (“CCDA”), effective since August 27, 2021, mandates that employers offering group health insurance to employees in Illinois provide a comparison of their plan’s covered benefits against Illinois’s essential health benefits (“EHBs”). In 2025, updates to the CCDA’s model disclosure form have been issued, ensuring employees have access to the most current and accurate information regarding their coverage.

Key Requirements of the CCDA

1. Who Must Comply: The CCDA applies to all employers with Illinois-based employees, regardless of the employer’s size or location. This includes employers offering fully insured or self-funded group health plans.
2. Disclosure Obligations: Employers are required to provide employees with a written comparison of their group health plan’s benefits to Illinois’s EHBs. The Illinois Department of Labor (“IDOL”) provides a model disclosure form, which has been updated for 2025 to ensure compliance with the law.
3. Delivery and Timing: The disclosure must be provided upon hiring an employee, annually, and upon an employee’s request. Employers can distribute the disclosure electronically (e.g., via email, the company intranet, or online benefit portal) or in print.

2025 Update: New Model Disclosure Form

For 2025, the IDOL has released a revised model disclosure form, available on its official website. Employers are encouraged to use this updated form to ensure compliance. The revised form clarifies benefit comparisons, ensuring employees have a clear understanding of which essential health benefits are covered under their employer-provided plan.

Enforcement and Penalties

The IDOL enforces compliance, with penalties for non-compliance ranging from $500 to $5,000 per violation, depending on the offense. Employers must maintain records of their disclosures for at least one year to demonstrate compliance during potential audits.

Recommendations for Employers

To remain compliant with the CCDA and avoid penalties employers should:

• Review Your Plan Benefits: Compare your group health plan to Illinois’s EHB requirements.
• Update Disclosures: Utilize the IDOL’s updated 2025 model disclosure form to provide accurate benefit comparisons to employees.
• Ensure Timely Distribution: Implement a process to ensure disclosures are provided on time, including at hiring, annually, and upon request.
• Maintain Records: Keep detailed records of when and how disclosures are provided to employees.

ERISA Preemption Considerations

The application of the CCDA to self-funded plans remains a topic of legal debate due to potential preemption under the Employee Retirement Income Security Act (“ERISA”). The IDOL asserts that the CCDA applies to all group health plans since employers are only required to issue notices, not adjust or limit benefit plan designs. To ensure compliance, Wisterm recommends that employers with either a fully-insured plan or a self-funded plan comply with the CCDA notice requirement.

Final Thoughts

Adhering to the Illinois Consumer Coverage Disclosure Act is critical for employers to maintain compliance and foster transparency. By incorporating the 2025 updates, including the revised model disclosure form, employers can ensure they meet their obligations and provide employees with clear, comprehensive health coverage information.

For more details on the updated model disclosure form, visit the Illinois Department of Labor’s website.

Additional Resources

• IDOL CCDA Webpage
• Consumer Coverage Disclosure FAQ
• Model CCDA Model Disclosure Notice (en Español)
• Illinois Consumer Coverage Disclosure Act
• Illinois List of Essential Health Benefits (en Español)
• Illinois Benchmark Plan