"Key Developments in 2025: [1] Simplified ACA reporting allowing Form 1095-C to be distributed only upon request; [2] New fiduciary certification requirement for comparative analyses of NQTLs; [3] End of telemedicine exception for HDHP/HSA plans; [4] New HIPAA privacy rights regarding lawful reproductive health care."  MORE >>

"HSA distributions for unreimbursed qualifying medical expenses are tax-free where incurred after establishing the account by HSA owners or their eligible dependents. Individuals can also roll over or transfer HSA balances to another custodian without tax consequences. Non-medical distributions are subject to ordinary income tax and (if under age 65) a 20% additional tax."  MORE >>

"[E]mployee contributions were scheduled to begin on July 1, 2025, with benefits commencing one year later on July 1, 2026. However, the Maryland Department of Labor is now proposing a delay until January 1, 2027, for deductions and January 1, 2028, for benefits[.]"  MORE >>

"Massachusetts has passed a new state law that requires pharmacy benefit managers (PBMs) to get a license from the Massachusetts Division of Insurance no later than January 1, 2026.... PBMs that fail to obtain or renew state licenses as required, violate other state PBM laws, cause multiple consumer complaints, or commit fraud are all subject to punishment by state insurance regulators."  MORE >>

"A federal district court in Maryland has issued a nationwide temporary restraining order (TRO) that preliminarily bars the second Trump administration from enforcing parts of recently issued executive orders that prohibit federal funding to hospitals and other medical institutions that provide gender-affirming care. The court concluded that the challenged provisions of the orders are likely to be found unconstitutional on various grounds. Relatedly, a federal district court in Washington State concluded that a Trump administration order addressing health care violated the Constitution's separation of powers." [PFLAG, Inc. v. Trump, No. 25-0337 (D. Md. Feb. 13, 2025); State of Wash. v. Trump, No. 25-0204 (W.D. Wash. Feb. 16, 2025)]  MORE >>

"[1] Rising utilization and medical expenses in Medicare Advantage ... [2] The ongoing impact of Medicaid redeterminations ... [3] Managing premium deficiencies and financial sustainability ... [4] Regulatory challenges and compliance burdens ... [5] Digital transformation and member engagement ... By focusing on data-driven care models, value-based arrangements and community partnerships, health plans can position themselves to thrive in the complex healthcare environment of 2025 and beyond."  MORE >>

"Texas state Rep. Cody Harris ... introduced a bill that could prohibit a health insurer, a health maintenance organization or any other health benefit plan issuer with a financial interest in a PBM from requiring a plan participant to use the PBM.... [The bill would prohibit] health benefit plan issuers and PBMs from using cost-sharing rules or other benefit design rules to encourage patients to use pharmacies affiliated with the issuers or PBMs."  MORE >>

"California could become one of only a handful of states that require insurers to disclose denial rates and reasoning, statistics the industry often considers proprietary information. The measure also seeks to force insurers to be more judicious with denials and would fine them up to $1 million per case if more than half of appeals filed with regulators are overturned in a year."  MORE >>

"AEP contended, and the district court agreed, that the severance plan was a top hat plan.... the court agreed with the district court that the plan provided 'deferred compensation,' was not subject to ERISA's fiduciary rules, and thus the fiduciary exception to the attorney-client privilege did not apply." [Kramer v. American Elec. Power Exec. Severance Plan, No. 24-3174 (6th Cir. Feb. 10, 2025)]  MORE >>

"While there was some initial reluctance to apply the unclean hands doctrine to enforcement suits brought under ERISA, 'because its application would significantly harm innocent parties, namely, participants and beneficiaries,' federal courts have considered and applied the doctrine of unclean hands to bar a plaintiff's recovery in an ERISA action. If a claim is equitable in nature under ERISA Section 502(a)(3), the unclean hands doctrine is available as a defense. "  MORE >>