"[T]he principles of 29 CFR Section 825.207(d) and (e) apply to leave under a state or local paid family or medical leave program that is also FMLA-qualifying. As such, the employer must designate the leave as FMLA leave, and where state law permits, the employer and employee may agree to use the employee's accrued paid leave from the employer to supplement the state or local payments. However, because leave under such programs is not unpaid, the FMLA's substitution provision does not apply, and thus, neither the employer nor the employee may unilaterally require that employer-provided accrued paid leave run concurrently with the paid state or local family or medical leave."  MORE >>

35 pages. "This 2026 Final Letter provides updates on operational and technical guidance for the 2026 plan year for issuers seeking to offer qualified health plans (QHPs), including stand-alone dental plans (SADPs), in the Federally-facilitated Exchanges (FFEs) or the Federally-facilitated Small Business Health Options Programs (FF-SHOPs). It also describes how parts of this 2026 Final Letter apply to issuers in State-based Exchanges on the Federal Platform (SBE-FPs). Issuers should refer to these updates to help them successfully participate in any such Exchange in 2026."  MORE >>

"[E]mployers and health coverage providers will now be able to more easily comply with distribution requirements for Forms 1095-B and 1095-C when handling ACA reporting, as those forms will only need to be distributed upon the request of an employee/covered individual.... Employers and health coverage providers will now be permitted to distribute Forms 1095-B and 1095-C electronically ... Applicable large employers (ALEs) will now have ninety [90] days to respond to a Letter 226-J from the IRS proposing employer shared responsibility penalties (ESRPs)."  MORE >>

"Although the Paperwork Burden Reduction Act simplifies the Form 1095-C distribution process at the federal level, this Act does not change the distribution requirements for states with individual health insurance mandates (e.g., California, New Jersey, Rhode Island, etc.)  ... Now that the federal rules allow an ALE to count posting the 'Notice of Availability' as a method of properly 'furnishing the Forms 1095-C to employees,' it seems reasonable to take the stance that if an employer provides the Notice of Availability to its employees, it will have satisfied both the federal and California state furnishing requirements."  MORE >>

"Among a slew of recent class action litigation involving employers' tobacco surcharge programs, the outdoor retailer Bass Pro Shops recently agreed to a $4.95M settlement for a lawsuit filed last spring alleging that the surcharge [the company] required tobacco users to pay for their health insurance was unlawful. This settlement should prompt employers who have a tobacco surcharge program to review their program to make sure it's compliant."  MORE >>

"The new version is methodologically similar to prior AVC models after two years in a row of substantial data updates and methodological changes.... [I]nflation continues to drive high trend which will push a number of plans outside the upper ends of the de minimis ranges.... [T]he 2026 Maximum Out of Pocket limit (MOOP) saw its biggest increase ever to $10,150 from $9,200 in 20252. The offsetting results of these two changes will be explored [in this article]"  MORE >>

"New York is the first state in the U.S. to pass a law entitling workers to paid prenatal leave. The law, which took effect on January 1, 2025, requires private sector employers, regardless of size, to provide their New York-based employees with 20 hours of paid leave for prenatal healthcare services during their pregnancy, or related to their pregnancy, during any 52-week calendar period."  MORE >>

60 pages. "Key findings in this [FTC] staff report include: [1] The Big 3 PBMs marked up numerous specialty generic drugs dispensed at their affiliated pharmacies by thousands of percent, and many others by hundreds of percent.... [2] A larger share of commercial prescriptions for the most profitable specialty generic drugs were dispensed by the Big 3 PBMs' affiliated pharmacies compared with unaffiliated pharmacies.... [3] The Big 3 PBMs' affiliated pharmacies generated over $7.3 billion of dispensing revenue in excess of NADAC on specialty generic drugs over the study period.... [4] In the aggregate, the Big 3 PBMs also generated significant income on the specialty generic drugs assessed in this report from spread pricing ... [5] Plan sponsor expenditures and patient cost sharing on specialty generic drugs increased at double-digit compound annual growth rates during the study period."  MORE >>

"[1] Unlock the power of HDHPs and HSAs ... Consider implementing Health Payment Accounts ... Promote the benefits of preventive care ... Implement cost transparency tools ... [2] Engage employees to boost benefits adoption ... [3] Bring technology into the mix."  MORE >>

"An employee with a zero-dollar balance at the end of the plan year under an FSA with a grace period is considered HSA‐eligible during the grace period (assuming the employee is otherwise HSA-eligible), as the IRS permits FSA coverage during a grace period to be disregarded under these 'zero dollar' circumstances for the purpose of determining HSA eligibility. However, note that FSA participants are not permitted to forfeit any portion of their year-end FSA balance to achieve a zero-dollar balance as of the start of the new plan year."  MORE >>

"Nationally, telehealth claim lines climbed from 4.80 percent of medical claim lines in September to 4.89 percent in October, an increase of 2.0 percent. In the Northeast, the increase was 1.0 percent; in the South, it was 1.2 percent; and, in the West, it was 2.8 percent. In the Midwest, however, the telehealth share of medical claim lines decreased by 3.7 percent. The data represent the commercially insured population, excluding Medicare Fee-for-Service, Medicare Advantage and Medicaid."  MORE >>