Point C is a leader in healthcare plan compliance. We offer proactive regulatory support designed to protect a client’s plan, members, and organization so employers can focus on running their business. Our in-house team continuously monitors legislation, evaluates its implications for the health plan, and develops solutions that reduce costs and minimize risk. Point C clients get routine access to best-in-class industry experts and attorneys who provide independent consultation and evaluation. And we partner with leading industry associations to drive change that serves the best interests of our clients — not the insurance carriers.

Compliance isn't a checkbox. It's a competitive advantage.

 

How Compliance Has Evolved

The rules have changed and the stakes are higher than ever. Health plan compliance is no longer an administrative task; it's a fiduciary responsibility. New federal transparency mandates, the Consolidated Appropriations Act, and evolving state reporting requirements have fundamentally shifted what plan sponsors are expected to know, document, and execute. Penalties can result in $100 per day per participant, and regulators are increasingly scrutinizing self-funded plans.

Point C exists to make sure a client is never caught off guard.

 

How Point C Helps Clients Stay Ahead

• Regulatory Monitoring We track every relevant federal and state development and inform what it means for a client’s plan.
• Filing & Attestation Execution Required submissions, attestations, and regulatory filings are completed on a client’s behalf, on time, every time.
• Audit-Ready Documentation We maintain the records and documentation a client needs to respond to regulatory scrutiny with confidence.
• Fiduciary Oversight Support We help a client meet their obligations as a plan sponsor — protecting them from personal liability and regulatory exposure.
• Risk Reduction From missed deadlines to incomplete reporting, we identify and close the gaps before they become penalties.
• Accessible Expertise Unlimited access to compliance specialists and independent attorneys who provide the guidance a client’s plan deserves.
  

 

Federal Compliance, Fully Managed

The Consolidated Appropriations Act and Transparency in Coverage rules created a new layer of compliance obligations for plan sponsors. Point C handles every requirement from data aggregation to regulatory filing, so nothing gets overlooked.

• Member Price Comparison Tool Federal law requires plan sponsors to give participants real-time access to cost information before they receive care. Our Member Price Comparison Tool fulfills this mandate giving members the ability to compare healthcare pricing across providers and make informed decisions. Plans that fail to provide required price transparency tools face penalties of up to $100 per day per affected participant.
• Machine Readable Files (MRF) The federal government requires health plans to publish comprehensive pricing data in machine-readable format that is publicly accessible and updated on a regular basis. We prepare, maintain, and publish MRFs on an ongoing basis, keeping clients in full compliance without placing any burden on an employer’s internal team. Failure to publish or maintain compliant MRFs exposes plan sponsors to enforcement action and potential excise taxes.
• RxDC Submission Every year, self-funded plans must submit detailed prescription drug and healthcare spending data to the federal government. This requires aggregating data from multiple vendors such as a plan’s PBM, TPA, stop-loss carrier, and others and submitting a unified, compliant report. We manage the entire process: data collection, aggregation, validation, and submission, all completed on a client’s behalf. Plans that fail to submit or submit inaccurate RxDC data face regulatory scrutiny and potential penalties under the CAA.
• Gag Clause Attestation Federal law prohibits plan sponsors from entering contracts that restrict access to cost and quality data. Each year, plan sponsors must attest to their compliance with this prohibition. We coordinate the annual attestation process and submit the required documentation to the appropriate federal agencies if a client chooses to opt into the process. Failure to attest is a reportable violation that can trigger audits and erode plan sponsor credibility with regulators.

 

State Compliance, Monitored and Executed for Clients

State-level reporting obligations are complex, jurisdiction-specific, and easy to miss. We track them all. Self-funded health plans operating across multiple states face a patchwork of reporting requirements such as state assessments, vaccine reporting mandates, and jurisdiction-specific regulatory documentation. Point C monitors and executes applicable state-level obligations on a client’s behalf, ensuring they remain compliant in every market where a plan operates.

Regulatory Monitoring & Recommendations Compliance doesn't stand still and neither do we. We continuously track federal and state regulatory developments, enforcement trends, and industry guidance. When something changes that affects a client’s plan, we proactively move our operations and communications towards compliance before it becomes a problem.

ERISA & Self-Funded Compliance Consultation (On-Demand) Have a compliance question mid-year? Don't wait until renewal time to get an answer. Plan sponsors and their teams have direct access to Point C compliance specialists and attorney consultants for guidance on regulatory considerations, plan administration questions, and practical implementation approaches for new requirements, whenever needed.

Operational Compliance Integration Compliance only works when it's embedded in a client’s actual operation process. We collaborate directly with internal teams and vendors to ensure compliance considerations are part of day-to-day administration, not a separate checklist that gets reviewed once a year.

Plan Support & Compliance Guidance From broker questions to mid-year regulatory curveballs, Point C provides hands-on support throughout the plan year. Whether fielding a participant complaint, evaluating a vendor contract, or responding to a new regulatory requirement, our team is there to guide and be a partner through every step.

 

DISCLAIMER

Point C's Compliance Services program supports operational execution and regulatory adherence ensuring a client’s plan meets its filing, reporting, and transparency obligations. These services do not constitute legal or tax advice and are not a guarantee of compliance or limiting regulatory or legal risk. Plan sponsors should consult qualified legal counsel for legal interpretation, plan document review, and matters requiring formal legal opinion. Point C works alongside client’s legal advisors, not in place of them, to ensure our clients have both the strategic guidance and the operational execution a plan requires. Some services listed here may have additional fees associated with them.