"As guidance on the Paperwork Burden Reduction Act has not yet been issued, employers that wish to adopt the new optional distribution form right away (i.e., for 1095-Cs that will be available in early 2025 for the 2024 year) should consider working with legal counsel to address open issues. Employers with employees in states that have their own minimum essential coverage requirements should be aware that distribution of 1095-Cs in those states is required unless the states adopt the new optional method. Employers should continue to solicit TINs to ensure they are in compliance with the rules for using full name and DOB as an alternative."  MORE >>

"[Rev. Rul. 2025-4] aims to clarify the federal tax treatment of state paid leave programs that help pay employees who cannot work because of non-occupational injuries to themselves or family members as well as sickness and disabilities. Under the guidance, employers may generally deduct contributions to mandatory PFML programs as a payment of excise tax. Likewise, employees may deduct contributions as income tax payments if they itemize their deductions. Payments to employees from a state PFML program must be included in the employees' gross income."  MORE >>

"[T]he DOL opined that while state and local PFML programs are not directly addressed in the FMLA regulations, the same principles apply to such programs as those that apply to employees that receive payments on FMLA from workers' compensation insurance programs or disability plans."  MORE >>

"Colorado offers employers extra protections when it comes to health-related time off. In 2025, there are two key programs to consider: the FAMLI (Family and Medical Leave Insurance) program and the HFWA (Healthy Families and Workplaces Act). Both programs are designed to support employees' health and family care needs, but they differ in scope and specific provisions."  MORE >>

"Equivalent Plans must allow for the same, or more comprehensive, coverage than is expressly required by the Paid Leave Law.... [E]mployers can choose to use an Equivalent Plan to cover one leave category (family or medical) and can participate in Minnesota's Paid Leave program to cover the other leave category (family or medical)."  MORE >>

"Beginning November 21, 2024, under the Act, an employee may use earned sick time for these events: a pregnancy loss, unsuccessful assisted reproduction such as in vitro fertilization (IVF), or a failed adoption or surrogacy, as well as to address both physical and mental effects of such an event on an employee or the employee's spouse."  MORE >>

"[T]he district court dismissed the plaintiff's ERISA fiduciary breach claims for lack of Article III standing, finding that the plaintiff's allegations that she paid too much in premiums, copays, and coinsurance and that her wages were adversely impacted by prescription drug costs were speculative 'at best' and that her allegations regarding higher out-of-pocket costs for prescription drugs were not redressable." [Lewandowski v. Johnson & Johnson, No. 24-0671 (D.N.J. Jan. 24, 2025)]  MORE >>

"In 2025 and beyond, there is a tremendous opportunity for small to mid-sized employers to switch to a type of self-funding called a Group Health Insurance Captive.... Together, these employers can pool their risk, leverage economies of scale, and create and administer their own high-performing, self-funded health plan. This sharing of responsibility means that captives are less risky and come with a lower administrative burden than traditional self-funded plans operated by a single employer."  MORE >>

"[1] Implement a system for regular compliance reviews, and ... assess the impact of legislative changes on your organization's benefits programs.... [2] Invest in reliable HR technology platforms, ... [3] Conduct annual non-discrimination testing and ... address any discrepancies early.... [4] Develop a state-by-state compliance checklist and partner with vendors who understand regional nuances.... [5] Work with IT teams to implement robust cybersecurity measures ... Regularly review vendor agreements to ensure they meet data protection standards."  MORE >>

"[KFF] found significant variation between companies, with denial rates ranging from as low as 1% to as high as 54%. Among insurers with a high volume of claims, Blue Cross and Blue Shield of Alabama had the highest denial rate for in-network claims at 35%, followed by UnitedHealth Group at 33%. Illinois-based Health Care Service Corp., which runs nonprofit Blue Cross plans in five states, had the third-highest denial rate at 29%."  MORE >>

"The National Community Pharmacists Association (NPCA) is warning the feds that independent pharmacists are likely to face significant financial hardship due to Medicare drug price negotiations.... [T]he organization says it conducted a survey of 8,000 pharmacy owners and managers about the drug price negotiation program and found that 93.2% have either decided not to stock drugs under negotiation or are considering not stocking these products."  MORE >>

"Over the years, the DOL has issued a series of PTEs for captives created by employers -- typically to reinsure benefit risks arising under the employer's employee welfare benefit plans ... while also allowing for deduction of the premiums as trade or business expenses. And, in July 2024, the DOL proposed a significant PTE that would allow an employer's captive insurer to reinsure pension annuity risks. Accordingly, employers that successfully secure PTEs for captive insurance in the future need not be concerned with the IRS' onerous 'listed transaction' rules."  MORE >>