"The final instructions do not explain the criteria CMS will use to determine whether a plan provides 'reasonable coverage' or 'reasonable access.' The requirement to cover at least 72% of participants' prescription drug expenses is an increase from the current simplified methodology's 60% requirement. Plan sponsors will likely need to review their prescription drug coverage with their consultants to ensure it continues to provide creditable coverage under this new methodology."  MORE >>

22 presentation slides. Topics: [1] Grab bag: 125 Issues, TIN solicitation, 4980H penalties, SCOTUS; [2] Prescription drug/PBM round up; [3] Braidwood update; [4] Taxation of California infertility coverage; [5] Reimbursement of medical travel expenses; [6] Life insurance eligibility enforcement; [7] Top 10 COBRA compliance issues.  MORE >>

"Some people (mostly men) are delaying or deferring care ... There is also a gender gap for preventive screenings ... Overall medical inflation grew 12.6% on average over the last two years. Overall prescription inflation rose 15% on average over the last two years.... Supplemental and voluntary offerings have increased to 43.49% in 2025 from 41.27% in 2023. Participation rates increased year-over-year in every generational group."  MORE >>

"[E]mployers have increasingly hiked up deductibles and employees' cost-sharing liability for self-funded plans to avoid steep premium increases ... Enter companies like Centivo ... [which] saves money in part by prioritizing primary care, going so far as to launch a virtual clinic with free appointments for members ... Centivo also contracts directly with healthcare providers, intentionally choosing affordable health systems."  MORE >>

"By embracing a proactive approach to Medicare education and support, organizations can reduce the confusion and stress that comes with understanding Medicare coverage and potentially reduce health benefit costs.... Further, many employees do not understand that they have options after age 65, even if they are still actively working. Without proper guidance, they may face costly penalties, delayed coverage, or missed opportunities for savings."  MORE >>

"[O]nly 37% of companies with 500 or more employees provide at least one benefit geared toward maternal health.... 45% of mothers have seriously considered leaving their job after their most recent pregnancy and 47% looked for job options with better support during the return-to-work process. For Gen Z moms, these numbers spike to 62% and 64%, respectively."  MORE >>

"Where does employee satisfaction rest, and how is it best achieved? Perhaps by offering a large menu of benefits that meet the employees' life stage needs.... Voluntary benefits are becoming more integrated with medical, disability and leave. This results in reminders to the insured that they may be eligible for benefits and how they can take action to assist in filing for benefits.... Timely data, the cadence of file delivery and how data is shared for submitted or settled core claims can be critical in generating the most positive outcomes."  MORE >>

63 pages. "This report provides overviews of and data on key topics including types and administration of exchanges, eligibility and enrollment, qualified health plan features (benefits, costs, and financial assistance), provider networks, insurer participation, enrollment assistance, and exchange financing. It also includes information about recent statutory and administrative policy changes and current policy issues related to the exchanges and QHPs." [R44065 updated May 6, 2025]  MORE >>

"Over a dozen bills expanding HSAs were introduced in the first four months of 2025 ... [P]olicymakers should reject expansions of HSAs: [1] HSAs mostly benefit people with high incomes ... [2] HSAs don't improve health care affordability and access, and they don't make spending more efficient ... [3] HSAs crowd out policies that would better help people afford coverage and care."  MORE >>

"Advisors are becoming increasingly aware that HSAs can be a leg of the retirement stool and compete for a share of employees' wallets. Embracing HSAs as part of their consulting strategy will allow advisors to have a seat at the table with respect to using HSAs as a tool in retirement planning."  MORE >>