23 pages. "[CMS is] revising the Final 2026 AV Calculator ... to accommodate potential new de minimis ranges and a potentially updated MOOP limit. The only changes that are being made to the Final 2026 AV Calculator ... [are] [1] The de minimis range for bronze, silver, gold and platinum plans was expanded to +2 percentage points to -4 percentage points; [2] The de minimis range for expanded bronze plans was expanded to +5 percentage points to -4 percentage points; [3] The de minimis range for income-based silver CSR plans was expanded to +1 percentage points to -1 percentage points; [4] The MOOP limit was updated to $10,600; and [5] The AV Calculator version number was updated, and the AV Calculator label was updated to 'Revised Final 2026 AV Calculator'. These changes do not affect the AV calculation methodology." [Also available: Revised Final 2026 Actuarial Value Calculator (XLSM)]  MORE >>

"With the passage of the Continuing Resolution (CR) ... current telehealth flexibilities and Medicare coverage for the benefit will not expire on March 31.... Certain provisions ... remain excluded, such as first dollar coverage of High Deductible Health Plans/Health Savings Accounts (HDHP-HSA)[.]"  MORE >>

"Barring extraordinary relief by the Missouri legislature or the Missouri Supreme Court, employers are required to provide written notice to their employees about the paid sick time by April 15. Employers should proceed as if the paid sick leave law will take effect on May 1, 2025[.]"  MORE >>

"The First Circuit also concluded that the wrongful death claim was preempted because it 'duplicates, supplements, or supplants the ERISA civil enforcement remedy' in 29 U.S.C Section 1132(a) and thus 'conflicts with the clear congressional intent to make the ERISA remedy exclusive.' This was true even though plaintiff was neither a plan participant nor a beneficiary with standing to sue under ERISA." [Cannon v. Blue Cross & Blue Shield of Mass., No. 24-1862 (1st Cir. Mar. 19, 2025)]  MORE >>

"The court found that the former employees could not satisfy Article III's standing requirements because their alleged harm is 'speculative and, ultimately, not redressable.' In addition, the court said it is speculative that the allegedly excessive fees the plan paid to Express Scripts 'had any effect at all' on plaintiffs' contribution rates and out-of-pocket costs for prescriptions." [Navarro v. Wells Fargo & Co., No. 24-3043 (D. Minn. Mar. 24, 2025)]  MORE >>

10 pages. "When asked about strategic organizational priorities related to offering health and benefits plans, most employers ranked attracting and retaining talent as #1.... Employers ranked controlling cost as the most critical focus for their 2025 health and well-being plans and a top three priority overall.... Employers are offering several programs or are actively considering investing in a number of different services to fill in the gaps for an ever-changing and evolving workforce."  MORE >>

"The first step in determining what terms should be in the purchase agreement and what to review in the due diligence process is to identify what plans the seller maintains. While the seller is usually required to disclose all of its benefit plans, written or unwritten, as a part of the purchase agreement, it is a best practice to verify this through a review of documents ... Some benefits need more scrutiny to determine the absence of significant problems."  MORE >>

"The percentage of workers who want reproductive and maternal health benefits exceeds the percentage of employers that offer these benefits ... This gap is particularly large for contraceptive access and coverage, abortion access and coverage, fertility services, leave for pregnancy loss, post-partum care, lactation support, and menopause treatment. And it's not just women workers who care about these employee benefits."  MORE >>

"[1] Start the RFP process early -- and be specific ... [2] Deprioritize member disruption as a decision factor ... [3] Be wary of PBM coalition arrangements ... [4] Think beyond the spreadsheet ... [5] Break the addiction to rebates."  MORE >>

10 pages. "As the pharmacy distribution market considers emerging reimbursement models, stakeholders are seeking solutions that support several key principles: [1] Cost-plus inspires stakeholders' confidence that reimbursement will be stable and cost-correlated [2] Consistent financial performance over time [3] Model conversion that is fiscally neutral for stakeholders ... [T]his whitepaper describes a framework for evaluating widespread adoption of a cost-plus pricing methodology for the pharmacy distribution model."  MORE >>

"The BA's reports indicated that a software misconfiguration resulted in ePHI stored on its servers being accessible on the internet and subject to automated web crawlers (search devices) beginning in August 2015. However, the BA did not discover the breach until nearly three years later -- in June 2018."  MORE >>

"[T]he sheer complexity of ERISA and of its application in specific circumstances often requires multiple decisions by multiple courts before a consensus is reached on what the correct rule on a given issue actually should be.... [P]erhaps the best solution is a structure that feeds any conflicting circuit court opinions automatically to a designated and specialized appellate bench above the circuit courts but below the Supreme Court, to maximize the opportunities for such diverse decisions to be synthesized."  MORE >>