22 pages. "The AV Calculator represents an empirical estimate of the AV calculated in a manner that provides a close approximation to the actual average spending by a wide range of consumers in a standard population. This document is meant to detail the specific methodologies used in the AV calculation." [Also available: Final 2026 Actuarial Value Calculator (XLSM)]  MORE >>

"For the 2025 plan year, the OOP limits are set at $9,200 for self-only coverage and $18,400 for family coverage. These limits will see an increase in 2026 to $10,150 for self-only coverage and $20,300 for family coverage."  MORE >>

"[This article provides] answers to the most commonly asked questions for ACA reporting requirements, guidance on which forms are required to complete, upcoming deadlines, and more to remain compliant."  MORE >>

"Although the Departments will continue to require plans to complete a comparative analysis, the final rules declined to provide an exhaustive list of the NQTLs that should be analyzed, leaving an almost infinite pool of potential NQTLs for plans to consider.... For now, the Departments point plans and issuers towards their reports to Congress [in 2023 and earlier] that list NQTLS on which the Departments have focused their enforcement efforts or have found the most noncompliance, as well as the 2020 Self Compliance tool that includes an illustrative non-exhaustive list."  MORE >>

"Under the final rules, at least one plan fiduciary must certify that the fiduciary has engaged in a prudent process to select a qualified service provider to prepare the NQTL comparative analysis. The fiduciary must also certify that the fiduciary has engaged in a process to monitor the service provider's performance. The process for the fiduciary should include, at a minimum, asking questions about the analysis and discussing it with the service provider to understand the findings and conclusions.... The fiduciary certification requirement is effective for plan years beginning on or after January 1, 2025."  MORE >>

"All nursing employees are entitled to a 30-minute paid break to express breast milk each time an employee 'has reasonable need' to do so. The NY DOL's written policy on employees' rights to express breast milk must be provided at hire, annually, and when an employee returns from work following the birth of a child. Effective January 1, 2025, eligible employees will be entitled to 20 hours of paid prenatal leave, in addition to sick time."  MORE >>

Defendants" motion to dismiss has been fully briefed as of August 12. However, both Plaintiff and Defendants recently filed notices of supplemental authority citing to the Third Circuit's decision in Knudsen v. MetLife Group, Inc.... The Third Circuit held that Plaintiffs lacked standing to lead the suit because they couldn't show they were owed the rebate savings, thus failing to establish an injury-in-fact.... If Plaintiff successfully survives the dismissal, we can expect to see even more of these cases filed by plaintiffs' firms, regardless of the merits of the allegations. " [Lewandowski v. Johnson & Johnson, No. 24-0671 (D.N.J. complaint filed Feb. 5, 2024)]  MORE >>

"After investigating the circumstances and reviewing Shipton's medical documentation, BGE believed he had been misusing leave.... Shipton's conflicting paperwork and BGE's investigation reasonably gave rise to an honest belief on the part of the employer at the time of his firing that Shipton was misusing FMLA leave -- even if that later turned out not to be the case. Accordingly, the court found in favor of BGE and against Shipton on his FMLA retaliation claim." [Shipton v. Baltimore Gas and Elec. Co., No. 23-1360 (4th Cir. Jul. 31, 2024)]  MORE >>

"Some employers have been caught off guard since pregnancy-related leave, without extenuating medical complications, has largely been a function of company parental leave policies, particularly where a worker has not been employed long enough to qualify for other leave. Employers need to take note that they are now required to engage in the interactive process to determine whether an employee is entitled to an accommodation for a pregnancy-related condition -- even those not associated with complications -- such as normal childbirth and recovery time."  MORE >>

"Diabetes is generally the most expensive and fastest growing therapeutic class within the majority of corporate drug benefit plans. It presents a huge population health problem and affordability challenge. Yet, we are wasting ever more billions of dollars overtreating Americans with respect to diabetes and obesity."  MORE >>

"Today's employees, reflecting longer term generational trends, seek benefits that provide broad choice, flexibility, and value for their investment.... [E]mployees say their financial situation is their number one challenge -- but it's the area where employer support is least effective.... Over the past few years, employer have often prioritized emotional wellbeing, whereas employees say they need the most help with financial security."  MORE >>

"With states already beginning to experiment with various portable benefits models, the federal government can add to these efforts through seven comprehensive reforms that seek to ... [1] Remove barriers to benefits. [2] Create flexible benefits and savings opportunities. [3] Improve access to healthcare benefits."  MORE >>