"[1] Are HDHPs required to cover COVID vaccines with no cost-sharing? ... [2] If the ACIP's recommendation changes, can HDHPs continue to cover COVID-19 vaccines pre-deductible? ... [3] Can an HDHP cover other COVID testing and treatment pre-deductible?"  MORE >>

"As we close out the second quarter of 2025, the legal landscape across the United States continues to shift dramatically in the areas of abortion and gender-affirming care laws. This quarter has seen a wave of new state-level legislation and pivotal court rulings that are reshaping access to both abortion services and gender-affirming health care for minors."  MORE >>

"Employers will be required to report, by July 1, 2025, the number of children in New Mexico covered by their employer-sponsored group health plans. The reporting requirement comes from regulations under the state's Vaccine Purchasing Act, one of a handful of state laws that put surcharges on health insurers, group health plans, third-party administrators, or some combination, to fund states' purchases of vaccinations for children in the relevant state."  MORE >>

"Before this amendment, the paid sick leave laws in Pittsburgh and Allegheny County used the same accrual rate and permitted employees to accumulate and annually use the same amount of paid sick leave. With these amendments, Pittsburgh employees will have faster accrual and higher accumulation and usage caps than employers elsewhere in Allegheny County."  MORE >>

"S126's Reference-Based Pricing model and expanded hospital budget oversight are designed to slow the growth of hospital spending, which is a major driver of premium increases. Over time, this could translate to more stable or even reduced premium trends for Vermont health plans. The cumulative effect of drug pricing caps and hospital payment reforms is expected to yield ongoing savings for both employers and employees."  MORE >>

"The court explained that although Guardian’s right to cancel vested in November of 2019, there was “a conspicuous 10-month gap between that date and when Guardian started ‘temporarily suspending’ plan cancellation in September 2020 due to COVID.” Furthermore, after its right to cancel vested, Guardian continued to accept 26 months’ worth of premiums." [Edwards v. Guardian Life Ins. of Am., No. 24-60381 (5th Cir. June 20, 2025)]   MORE >>

"Dozens of insurance companies ... agreed to several measures ... [M]any people may not notice a difference, even if insurers follow through on their new commitments.... Prior authorization isn't going anywhere.... Reform efforts aren't new.... Insurance companies are already supposed to be doing some of these things.... Health insurers will increasingly rely on artificial intelligence.... Key details remain up in the air."  MORE >>

"Artificial Intelligence (AI) offers healthcare finance professionals powerful tools to shift denial management from reactive to proactive, significantly enhancing operational efficiency and financial performance. This article explores the use of AI technologies in preventing and managing denials, outlines an implementation strategy, presents case studies, and discusses challenges and future trends."  MORE >>

"This guide breaks down how to manage GLP-1 coverage through strategic plan design, maximize biosimilar adoption, and ask the right questions of your PBM to ensure transparency, affordability, and better outcomes."  MORE >>

"These programs may be offered as a true 'subscription service' ... or they may be offered with some form of financial risk-pooling.... [E]ntities offering or considering offering such solutions, as well as employers and other payors considering utilizing them, may want to consider whether any insurance regulatory issues are presented by the programs."  MORE >>

"[The authors] provide evidence, from a novel survey of respondents who administer or oversee health benefits for their companies, that many employers appear to neglect even the most basic of their fiduciary obligations to their employees. This neglect may help explain the poor performance of employer plans in controlling costs and providing access to healthcare, and it suggests that many employers may be vulnerable to liability from ERISA lawsuits. "  MORE >>

"First, it is clear that where medical regulation is concerned, the Court will give legislatures a wide berth.... Second, once a law is treated as one regulating other than a suspect classification, overcoming the law becomes a near-impossibility.... Third, the essence of the Court's decision -- that legislatures have extremely broad powers over health care regulation -- does not appear to have a clear stopping point.... Fourth, the decision offers clues about the outcome should the applicability of Section 1557 to cases involving transgender care ultimately reach the Court." [U.S. v. Skrmetti, No. 23-477 (S.Ct. Jun. 18, 2025)]  MORE >>

"[The EBSA Investigations Transparency Act (HR 2869)] would require DOL to make annual reports to Congress about ERISA investigations and targeted compliance monitoring conducted by [EBSA]. [The Balance the Scales Act (HR 2958)] would prohibit the agency from sharing information obtained during EBSA investigations with private litigants without first notifying affected plan sponsors and fiduciaries. Both bills were referred to the House Education and Workforce Committee."  MORE >>