"[T]he maximum annual limitation on cost-sharing for 2026 has been revised to $10,600 for self-only coverage and $21,200 for other than self-only coverage ... [superseding] the previously announced 2026 limit of $10,150 and $20,300.... Beginning with the 2026 plan year, insurers subject to the essential health benefits (EHB) requirement (i.e., non-grandfathered individual and small group market plans) may not cover 'specified sex-trait modification procedures' as an EHB."  MORE >>

"Form 5500 due dates for health and welfare plans are a crucial piece of information to maintain compliance with ERISA regulations.... A missed or delinquent Form 5500 may be assessed penalties from both the IRS and the DOL.... Form 5500 must be filed electronically using the DOL's EFAST2 system."  MORE >>

"If the employer is an Applicable Large Employer (ALE), then interns hired to work full-time hours should be treated the same as other full-time hires and offered coverage after the standard waiting period. Otherwise, the employer is at risk for potential penalties under the ACA's Employer Shared Responsibility mandate. There is a limited exception that may apply to employers using the look-back measurement method to determine the full-time status of their employees."  MORE >>

"Given that the ruling is unlikely to be challenged by the Department under the current administration, Plan Sponsors and Covered Entities should review their HIPAA Privacy Policy, HIPAA Notice of Privacy Practices, business associate agreements, and any other related HIPAA Privacy documentation to determine whether any updates are needed." [Purl v. HHS, No. 24-0228 (N.D. Tex. Jun. 18, 2025)]  MORE >>

"The employer here did many things right. They sent all the appropriate notices to the former employee and had proof of those mailings. They also responded to the former employee's request when it was made. However, this case is an example of just how far the duty of prudence may reach. The Court determined that the employer was expected to communicate thoroughly and with foresight, not just with a basic answer to the question posed." [Watson v. EMC Corp., No. 19-2667 (D. Colo. May 7, 2025)]  MORE >>

"A former Aetna actuary in the Medicare department won a $95 million False Claims Act judgment (PDF) against pharmacy benefit manager Caremark on Wednesday. She alleged Caremark prompted health insurers to misrepresent to the government the price paid for prescription drugs for Medicare beneficiaries. Importantly, the lawsuit claimed Caremark contracted with pharmacies to pay a fixed average price but caused higher prices to be reported." [U.S. ex rel Behnke v. CVS Caremark Corp., No. 14-0824 (E.D. Penn. Jun. 25, 2025)]  MORE >>

"National health expenditures are projected to have grown 8.2 percent in 2024 and to increase 7.1 percent in 2025 ... During the period 2026-27, health spending growth is expected to average 5.6 percent ... Each year for the full 2024-33 projection period, national health care expenditure growth (averaging 5.8 percent) is expected to outpace that for the gross domestic product (GDP; averaging 4.3 percent) and to result in a health share of GDP that reaches 20.3 percent by 2033 (up from 17.6 percent in 2023)."  MORE >>

"Among adolescents who received mental health treatment in the past 12 months, 45.3% received some care via telehealth.... High use of telehealth for mental health treatment for adolescents was concentrated in office-based specialty care."  MORE >>

"[T]he Prescription Drug Affordability Act [HB 1697] eliminates spread pricing, ends PBM steering practices, and mandates 100 percent rebate pass-through. It also institutes an oversight structure for PBMs that requires annual transparency reports, plan audits, and market conduct examinations."  MORE >>

"Health systems need to make interoperability a priority, not a side project. Insurers must deliver real transparency, not just check the compliance box. Employers should stop piling on point solutions and start demanding integrated platforms. And tech companies have to earn trust by delivering transparent value from day one."  MORE >>

"[T]he lower prices imposed by the IRA may diminish rebate and fee revenue flowing to PBMs. For PBMs to recoup the profitability gained from rebates and fees, PBMs may impose higher OOP costs on patients.... Without the prohibition of rebate contracting, it seems likely that IRA price controls and the President's MFN proposal will not succeed[.]"  MORE >>

"[I]ndividuals and businesses in parts of Missouri affected by severe storms, straight-line winds, tornadoes, and flooding that began on May 16, 2025 ... now have until Nov. 3, 2025, to file various federal individual and business tax returns and make tax payments.... [I]ndividuals and households that reside or have a business in the City of St. Louis and in Scott and St. Louis counties qualify for tax relief."  MORE >>

"President Trump reportedly has named the former chair of the [EEOC] to serve as acting Assistant Secretary of the [DOL's] Employee Benefits Security Administration (EBSA).... Although there currently is no official announcement on the White House's website, EBSA's website does list [Janet Dhillon ] as the acting Assistant Secretary.... In the meantime, the Senate HELP Committee is scheduled to vote [late Thursday June 26] on Daniel Aronowitz's nomination to be the Assistant Secretary of EBSA."  MORE >>