"The main impact of the nonenforcement action is on portions of the 2024 final rule that went into effect in 2025 and were scheduled to take effect in 2026. These were not specified in CAA, 2021 but were interpretations of how to implement the law.... Those include ... [1] Fiduciary certification process ... [2] Definitions for mental health and substance use disorder diagnosis and treatment ... [3] Meaningful benefit standard ... [4] Prohibition on discriminatory factors."  MORE >>

"The legislation, which goes into effect on September 1, 2025, requires that health insurance plans provide coverage for healthcare and dental services delivered through telemedicine to the same extent as if the services were provided through in-person consultations."  MORE >>

"[T]he Court ruled that Tennessee Senate Bill 1 does not require a higher level of constitutional scrutiny because its prohibitions rely on age and medical diagnosis, but not sex. Instead, the Court found that the Tennessee law met the lower requirements of 'rational basis' review, finding that age and medical treatment limitations were permissible uses of state authority." [U.S. v. Skrmetti, No. 23-477 (S.Ct. Jun. 18, 2025)]   MORE >>

"This decision will have significant consequences as over 20 states have enacted bans similar to the law in Tennessee ... It is uncertain what impact these statutes will have on the ability of employee benefit plans to continue to offer gender dysphoria coverage to minors." [U.S. v. Skrmetti, No. 23-477 (S.Ct. Jun. 18, 2025)]   MORE >>

"In addition to finding that the NSA does not contain a private right of action, the court held that the providers in Guardian Flight I did not have standing to enforce payment on IDR awards under ERISA, nor could they state a claim for unjust enrichment under Texas law. In Guardian Flight II, the court additionally held ... that the providers could not sue the certified IDR entity (CIDRE), because CIDREs are immune from suit under 'arbitral immunity.' The Guardian Flight cases presage a oncoming circuit split on the availability of judicial review of IDR awards, given the contrary district court precedent in other circuits."
[Guardian Flight, LLC v. Health Care Services Corp., No. 24-10561 (Guardian Flight I) and Guardian Flight v. Medical Evaluators of Texas ASO LLC, No. 24-20051 (Guardian Flight II) (5th Cir. Jun. 12, 2025)]  MORE >>

"Impeding use is the sheer amount of data that was dropped on the internet all at once, but not all in one place.... Currently, ... the MRF data is being used predominately by carriers and providers during contract negotiations, although plan sponsors are starting to explore how they might use the data.... [A] certain portion of the available data is still inadequate -- missing, unreasonable, or has some other issue -- which makes it difficult to use the data at a national level, especially in the context of a medical RFP where traditionally the margins of error have been slim."  MORE >>

"Advocates say this approach provides small companies that couldn’t afford insurance a chance to offer something. It also caps a growing expense for employers and fits conservative political goals of giving people more purchasing power over their coverage. But ICHRAs place the risk for finding coverage on the employee, and they force them to do something many dislike: Shop for insurance."  MORE >>