501 pages. "This final rule revises standards relating to denial of coverage for failure to pay past-due premium; ... establishes the evidentiary standard HHS uses to assess an agent's, broker's, or web-broker's potential noncompliance; revises the Exchange automatic reenrollment hierarchy; revises standards related to the annual open enrollment period and special enrollment periods; revises standards relating to ... de minimis thresholds for the actuarial value for plans subject to essential health benefits (EHB) requirements, and income-based cost-sharing reduction plan variations. This final rule also revises the premium adjustment percentage methodology and prohibits issuers of coverage subject to EHB requirements from providing coverage for specified sex-trait modification procedures as an EHB."  MORE >>

"Key finalized policies include revised standards relating to strengthening income verification processes; modifying eligibility redetermination procedures ... and pre-enrollment verification for special enrollment periods (SEPs) aimed at reducing improper enrollments and improving the risk pool."  MORE >>

"(CMS) is finalizing a major rule that will lower individual health insurance premiums by approximately 5% on average. It is also projected to save taxpayers up to $12 billion in 2026 by combating the surge of improper enrollments in the Affordable Care Act (ACA) Exchanges, reining in wasteful federal spending, and refocusing on making health insurance markets more affordable and sustainable for hardworking American families."  MORE >>

"The expansion of the definition of 'family member' extends this benefit to qualifying events related to the employee's spouse or civil union or domestic partner, biological, adopted, or foster child, stepchild or legal ward, a child of the employee's spouse or domestic partner, a legal guardian of the employee or the employee's spouse, or a person to whom the employee stands (or stands for the employee) in loco parentis or stood in loco parentis prior to the person turning 18, regardless of legal documentation.... The amendment introduces to Vermont law a new entitlement to 'safe leave.' "  MORE >>

"The Supreme Court ruled that a retired firefighter with Parkinson's disease could not bring claims under the ADA regarding changes to her post-employment health benefits.... The decision clarifies a circuit split by concluding that to have standing under the ADA, plaintiffs must hold or desire a job for which they can perform essential functions, thereby narrowing protections for retired employees." [Stanley v. City of Sanford, FL, No. 23-997 (S. Ct. Jun. 20, 2025)]  MORE >>

"Employers overseeing the day-to-day management of their plans should also be able to use the ruling to seek disclosure of information about the pricing and payment of claims, which in the past TPAs have been unwilling to share. In their role as an ERISA fiduciaries, TPAs will be obligated to disclose this information when requested by a plan administrator looking to properly administer its plan." [Tiara Yachts, Inc. v. Blue Cross Blue Shield of Mich., No. 24-1223 (6th Cir. May 21, 2025)]  MORE >>

"Though the business had only one employee when Pamela died, the court found that Allure's prior staffing history, payroll practices, and Pam's managerial control met ERISA's threshold for a covered employee benefit plan.... While Guardian did have contractual discretion to cancel coverage when participation fell below two employees, the court held that Guardian waived this right by continuing to accept premiums for more than two years after the right to cancel vested in November 2019." [Edwards v. Guardian Life Ins. of Am., No. 24-60381 (5th Cir. June 20, 2025)]  MORE >>

"Though the heightened protections for reproductive health information under HIPAA's Reproductive Health Rule have been eliminated, healthcare providers and others must continue to comply with HIPAA's Privacy Rule with regard to the privacy of PHI and heed state laws that may provide enhanced privacy for this specific category of health information." [Purl v. HHS, No. 24-0228 (N.D. Tex. Jun. 18, 2025)]  MORE >>

"Wesco alleges that BCBSM enrolled self-funded plans into [the 'Shared Savings Program'] without consent and then profited by charging up to 30% fees for correcting administrative errors caused by BCBSM itself." [Wesco, Inc. v. Blue Cross Blue Shield of Michigan, No. 25-11712 (E.D. Mich. complaint filed Jun. 9, 2025)]  MORE >>

"Health plans are voluntarily taking steps to improve prior authorization for patients and providers by: [1] Standardizing electronic prior authorization; [2] Reducing the scope of claims subject to prior authorization; [3] Ensuring continuity of care on benefit-equivalent prior authorizations when patients switch health plans; [4] Enhancing communication and transparency on prior authorization determinations; [5] Expanding near real-time response on prior authorization requests submitted electronically; and [6] Ensuring continued medical review of non-approved requests."  MORE >>

"HHS justifies much of the final rule by citing the need to address fraudulent and improper enrollment of consumers by agents, brokers, and web-brokers. Instead of directly regulating these entities (through, say, new penalties) or adopting other common-sense changes recommended by commenters (such as two-factor authentication), HHS adopts policies that will impose new burdens on consumers, insurers, and marketplaces that will lead to coverage losses. And HHS imposes many policies on a nationwide basis even though improper enrollments are concentrated in only some states that use the federally facilitated marketplace (FFM)."  MORE >>

"The PR Supreme Court determined that, even if a statute's language may be ambiguous, the final interpretation of such statute is ultimately under the courts' purview and not administrative agencies. Similar to U.S. law, Puerto Rico courts are no longer required to provide deference to administrative agencies." [Vázquez v. Consejo de Titulares y Junta de Directores del Condominio Los Corales, 2025 TSPR 56 (May 21, 2025)]  MORE >>

"The intersection of releases with ERISA governed benefits, as well as with a fiduciary's obligations, is a little backwater corner of ERISA law that ... can give rise to a great deal of misunderstanding and confusion in the relationship between plan sponsors and plan participants. This decision -- particularly since its guidance is likely to be borrowed in decisions and lawsuits elsewhere -- will help with those problems." [Schuman v. Microchip Technology Inc., Nos. 24-2624, 24-2978 (9th Cir. Jun. 5, 2025)]  MORE >>