"[T]he premium adjustment percentage for the 2026 benefit year is 1.6002042901 ($7,833/$4,895), which represents an increase in ESI premiums of approximately 60.0 percent over the period from 2013 to 2025.... [T]he 2026 maximum annual limitation on cost sharing is $10,150 for self-only coverage and $20,300 for other than self-only coverage. This represents an approximately 10.3 percent increase from the 2025 parameters of $9,200 for self-only coverage and $18,400 for other than self- only coverage.... [CMS is] establishing the values of the 2026 reduced maximum annual limitation on cost sharing at $3,350 for enrollees with household income greater than or equal to 100 percent of the federal poverty level (FPL) and less than or equal to 150 percent FPL, $3,350 for enrollees with household income greater than 150 percent FPL and less than or equal to 200 percent FPL, and $8,100 for enrollees with household income greater than 200 and less than or equal to 250 percent FPL."  MORE >>

"Due to the destruction caused by Hurricane Helene in September 2024, the [IRS] announced affected taxpayers will receive relief by postponing certain deadlines falling on or after each impacted state’s effective date and before May 1, 2025.... Deadlines applying to Health Savings Accounts (HSAs) that fall within this time period are also extended. This means that eligible taxpayers will have additional time to make 2024 contributions to their HSAs."  MORE >>

"The proposal builds on ... efforts to expand access to affordable, comprehensive health insurance while reducing administrative burdens and advancing health equity. It also attempts to reduce the incidences of broker-driven unauthorized enrollments and plan switching ... [This article focuses] on policies related to Marketplaces, insurance reforms, and Advance Premium Tax Credits (APTC)."  MORE >>

"[CMS] released a Request for Information (RFI) and a sample list of prescription drugs that the agency preliminarily intends to include under the proposed Medicare $2 Drug List Model ... Under the model, people enrolled in a participating Medicare prescription drug coverage (Part D) plan would have access to these drugs for a low, fixed copayment of no more than $2 for a month's supply per drug.... The generic drugs under consideration for inclusion in this model would not be subject to utilization management requirements at any network pharmacies. Participation in the model would be voluntary for Part D sponsors and, pending further development, could start as early as January 2027."  MORE >>

"[A table] summarizes state laws for private employers regarding voting leave for employees.... States with no statute or regulatory provisions applicable to private employers: Delaware, Florida, Hawaii, Idaho, Indiana, Louisiana, Maine, Michigan, Montana, New Hampshire, New Jersey, North Carolina, Oregon, Pennsylvania, Rhode Island, South Carolina, Virginia, and Washington."  MORE >>

"What are the basics employers need to know? [23 Q&As] ... Do employers have to use the state program or can private plans be substituted? [9 Q&As] ... What about a leave that will pose an undue hardship? [3 Q&As] ... What do employers need to begin doing now?  MORE >>

"Workers can file a claim for SDI or PFL benefits up to 30 days in advance of the first compensable day of disability regarding the claim; The Employment Development Department (EDD) must issue payments for SDI or PFL benefits to eligible claimants within 14 days of receipt of a properly completed claim ... and Workers will be eligible for 70-90% wage replacement (currently 60-70%), beginning January 1, 2025."  MORE >>

"Oklahoma’s appeal stems from an August 2023 decision in which the Tenth Circuit found that four specific provisions of a state law regulating PBMs—the Oklahoma Patient’s Right to Pharmacy Choice Act—were preempted by ERISA and Medicare ... The Oklahoma law was intended to increase access to pharmacies for patients and strengthen the bargaining power of independent pharmacies across the state." [PCMA v. Mulready, No. 22-6074 (10th Cir. Aug. 15, 2023; cert pet. filed May 10, 2024, No. 23-1213)]   MORE >>

"Article III standing [again] proves too high a hurdle for ERISA healthcare plan participants, this time a family challenging Premera Blue Cross' application of guidelines limiting residential treatment under ERISA's mental health parity provisions. But this decision is not all bad news for plan participants, as the Tenth Circuit also holds for the first time that ERISA's disclosure and penalty provisions apply to administrative services agreements (but, perhaps even more surprisingly, not to the guidelines themselves)." [S. v. Premera Blue Cross, No. 22-4056 (10th Cir. Oct. 1, 2024]  MORE >>

"The average annual premiums for employer-sponsored health insurance in 2024 are $8,951 for single coverage and $25,572 for family coverage. Over the last year, the average single premium increased by 6% and the average family premium increased by 7%.... On average, covered workers contribute 16% of the premium for single coverage and 25% of the premium for family coverage, lower than the percentages contributed in 2023."  MORE >>

"Traditionally, employees only engage with benefit packages during new hire onboarding and annual open enrollment. This approach can cause benefits fatigue, where employees focus on basic coverage while critical voluntary benefits get lost in the shuffle.... By engaging employees outside the pressure-cooker of open enrollment, companies can provide deeper dives into specific benefits, such as FSAs or EAPs."  MORE >>

"[The IRS] recently green-lit a new type of plan design that allows employees to direct employer contributions as needed.... Employers will need to consider managing limits, directing investments, vesting, portability, and other factors.... Allowing employees to elect where the employer contribution is directed adds complexity to plan administration between multiple vendors."  MORE >>

"Nearly half (48%) of employees who reported planning ahead said they intend to increase their retirement contributions during open enrollment, while among those who do not prepare ahead of time, only 19% planned on increasing their retirement contributions."  MORE >>

"[T]his article explores one approach to making disclosures simultaneously accessible and reasonably reliable. It also examines the possibility of mandating standardized reports of key features of a benefit program ... Each of these alternatives would entail formidable costs, however. Whether the economic benefits of improved comprehension suffice to justify those costs is an open question."  MORE >>