Lumelight Gag Clause Compliance

The Lumelight Gag Clause Compliance Service will notify identified plan vendors of the plan’s intention to consider any gag clauses found in their service agreements to be unenforceable as applicable under the Consolidated Appropriations Act, 2021 (CAA21) and complete the attestation requirements on behalf of the group health plan sponsor. Under the CAA21 group health plans are prohibited from entering into any agreements containing gag clauses, as defined by the rule, and must attest to their compliance, annually, through CMS’s HIOS system. The registration deadline to ensure timely filing and notification to vendors is December 9th each calendar year. After completing the signup form and accepting the Lumelight Gag Clause Compliance Service Terms & Conditions, you will be sent a copy of the information submitted. After receipt of your sign-up information, Lumelight will send your identified plan vendors compliance letter(s) on behalf of the plan and, following a 15-day delivery period, will file the plan’s attestation to CMS. Finally, you will receive a receipt of filing once CMS has accepted our submission on your behalf.

Our compliance specialists will be available to answer questions throughout the Gag Clause compliance information collection process via email at gagclause@lumelight.com.

To sign up for Lumelight Gag Clause Compliance Service, please complete the form on the next page. Click Here for more in-depth information regarding Gag Clause Compliance under the CAA21. This service is priced based on the number of vendors the plan intends to notify regarding the compliance of your service agreements and is priced as follows:

Up to 3 vendors:	$500
Additional vendors:	$100 each

*Please note that for purposes of this filing requirement a “plan” is considered the legal entity sponsored by an employer (or in certain cases an association, trust, committee, etc.), not a plan option. In most cases, each employer sponsors a single plan for their employees. Where this is not the case, the employer or plan sponsor is generally aware that they sponsor more than one legal plan. If you have questions about how many plans you sponsor and/or how many vendors are applicable to this compliance requirement, please contact us at gagclause@lumelight.com.

Tell us about yourself
Your Name*

First NameLast Name
Your Email*
example@example.com
Your Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Tell us about the company that will be using Lumelight Gag Clause Compliance Service to submit their Gag Clause Prohibition Compliance Attestation (GCPCA) to CMS
Employer Legal Name*
What is my "employer legal name"?
Employer EIN *
(must be in format xx-xxxxxxx)
Employer Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer Plan Type*
ERISA Plan Number*
The three-digit Plan Number that is included on the plan's Form 5500. If the plan is not required to file a Form 5500, enter 000.
Attestation Information
Which reporting year are you completing an attestation for?*
If you wish to attest for multiple years, please complete this form separately for each year.
What is a reporting year?
Are you attesting to the entire calendar year period?*
Should I attest to the entire calendar year?
You have indicated you are not attesting for the entire calendar year, what is the start and end date you wish to attest to?
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
Will you be attesting to all vendor agreements for the plan?*
Can I attest to some vendors and not all?
Major Medical NetworkPBM NetworkBehavioral Health NetworkOther
How many vendors will you be notifying for compliance purposes?*
How do I determine the number of vendors for my plan?
Please provide us with the information to notify your plan vendors
Vendor 1
Vendor 1 Company Name*
Vendor 1 Attention To
Vendor 1 Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Where can I find my vendors' addresses?
Vendor 2
Vendor 2 Company Name*
Vendor 2 Attention To
Vendor 2 Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Vendor 3
Vendor 3 Company Name*
Vendor 3 Attention To
Vendor 3 Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Vendor 4
Vendor 4 Company Name*
Vendor 4 Attention To
Vendor 4 Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Vendor 5
Vendor 5 Company Name*
Vendor 5 Attention To
Vendor 5 Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Vendor 6
Vendor 6 Company Name*
Vendor 6 Attention To
Vendor 6 Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Vendor 7
Vendor 7 Company Name*
Vendor 7 Attention To
Vendor 7 Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Vendor 8
Vendor 8 Company Name*
Vendor 8 Attention To
Vendor 8 Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Vendor 9
Vendor 9 Company Name*
Vendor 9 Attention To
Vendor 9 Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Vendor 10
Vendor 10 Company Name*
Vendor 10 Attention To
Vendor 10 Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Who should we contact for additional information?
Is this the same individual identified above?*
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
If you have a referral code, please enter it here:
Price
Discount
Total
Signature*

Powered by Jotform SignClear
Total Due

prevnext( X )
USDChoose a payment option below. If you wish to pay using a credit card, please select PayPal Checkout and 'Pay with Debit or Credit Card'.
Pay with PayPal

Choose from one of the PayPal options to make your payment.
Should be Empty:

Tell us about yourself

Tell us about the company that will be using Lumelight Gag Clause Compliance Service to submit their Gag Clause Prohibition Compliance Attestation (GCPCA) to CMS

Attestation Information

Please provide us with the information to notify your plan vendors

Vendor 1

Vendor 2

Vendor 3

Vendor 4

Vendor 5

Vendor 6

Vendor 7

Vendor 8

Vendor 9

Vendor 10

Who should we contact for additional information?