"Insurance carriers are responsible for paying the PCORI fee on behalf of a fully insured plan, but employers must pay the fee for any self-insured medical benefits, including general purpose health flexible spending accounts (FSAs) and health reimbursement arrangements (HRAs). For plans that offer a mix of fully-insured and self-insured benefits, both the insurer and the employer must pay fees."  MORE >>

"Health and welfare provisions in the law include: [1] Reinstatement and permanent relief for telehealth services covered by HSA-qualifying HDHPs before the deductible is met.... [2] Favorable HSA treatment for ... Direct Primary Care Service Arrangements.... [3] Permanence of employer tax-free payments up to $5,250 (indexed) for employees' qualified student loans.... [4] Permanence and enhancement of employer tax credit for Paid Family and Medical Leave.... [5] Higher income exclusion for dependent care assistance programs.... [6] Enhancement of employer-provided childcare tax credit.... [7] Enhancement of adoption assistance tax credit.... [8] Permanence of elimination of tax-free bicycle commuting reimbursements."  MORE >>

"[E]mployers will need to brace for the potential of increased enrollment due to various provisions of the Act which have been predicted to decrease Exchange enrollment. With more employees turning to employer sponsored plans, plan sponsors will be vulnerable to increases in premium costs, claims costs, penalty exposure, and compliance risk.... The Act includes a few other modest employee benefits changes which may further help to fortify non-health employer offerings and attract employees amidst the flux in the health benefits space."  MORE >>

"[A]mendments to Washington state's Paid Family and Medical Leave law (PFML) ... significantly broaden job restoration rights, attempt to address leave stacking issues, alter benefits continuation rights, and reduce minimum claim duration periods. The amendments are set to take effect on January 1, 2026."  MORE >>

"Act 29 prohibits retaliating against an employee who exercises her rights under the law ... creating a clear-cut list ... [1] No negative evaluations ... [2] No adverse employment actions ... [3] No use as performance or efficiency metric ... [4] No disciplinary measures ... [5] No retaliation or discrimination ... [6] No interference."  MORE >>

"A rapidly growing line of ERISA cases seeks to impose fiduciary standards of conduct -- developed by courts largely in the retirement plan context -- to health plan design choices. The most recent ... involves a new and potentially disruptive twist: plaintiffs allege that the university violated ERISA fiduciary duties by offering an allegedly imprudent health plan option." [Barbich v. Northwestern Univ., No. 25-6849 (N.D. Ill. complaint filed Jun. 20, 2025)]  MORE >>

"In considering whether to distribute the SMM versus an updated SPD, plan administrators should consider the number of modifications that need to be described and whether the use of the SMM alone would sufficiently apprise covered persons of their benefits, rights, and obligations under the plan."  MORE >>

"[S]top loss claims exceeding $2 million have risen 1,251% since January 2014, when the [ACA] eliminated caps on health benefit payments.... [L]arge claim frequency rose across four major stop loss reimbursement thresholds in the past year. Claims above $200,000 increased by 46 percentage points, those above $500,000 by 75 points, above $1 million by 112 points, and above $2 million by 247 points.... Combined, cancers and cardiovascular conditions accounted for more than 48% of total stop loss claim costs in 2024, up from 44% in 2021."  MORE >>

"As American policymakers continue to consider ways to lower U.S. costs for drugs, many are doing so by looking to the prices paid in other countries. This piece provides a framework for understanding the potential role of international prices in the U.S. system, describes the recent history of policymaking on these issues, and looks ahead to what could come next."  MORE >>

"Although deductibles and other patient cost-sharing requirements serve several purposes, including lowering insurance premiums by reducing the insurer's portion of health care costs, cost sharing can be a barrier to care, especially for low-income enrollees or those in poor health. To address this concern, there have been calls to increase the generosity of individual Marketplace plans.... When considering these types of options, it's important to understand how cost sharing interacts with premiums and the implications for who ultimately bears the costs of health care services."  MORE >>

"[E]mployers should: [1] Consider design changes to HDHPs for low- or no-deductible telehealth services and direct primary care services. [2] Review transportation fringe benefit plans to address the exclusion of bicycle commuting reimbursements and inflation adjustments. [3] Determine whether to revise educational assistance programs to incorporate the inflation-adjusted amount. [4] Decide whether to amend their DCAPs to allow for increased contributions. [5] Consider whether to establish a plan to make contributions to the new 'Trump Accounts.' [6] If subject to executive compensation limits ... consider changes to compensation structures to avoid tax or loss of deduction."  MORE >>

"The final OBBB does not change or eliminate any tax incentives for employer-provided health coverage or retirement savings plans.... [P]rovisions related to PBMs were removed from the final bill that was signed into law.... The final version of the OBBB did not include any significant changes regarding retirement plans."  MORE >>

"Employee benefit plan audits involve numerous moving parts that extend well beyond meeting filing deadlines, requiring coordinated efforts among HR, accounting, legal counsel and third-party administrators. The complexity of ensuring ERISA compliance and verifying participant eligibility demands that HR professionals often wear multiple hats throughout the process."  MORE >>

"Over 6 in 10 employees say their benefits packages make them more inclined to stay with their current employer, with 41% saying their benefits make them much more inclined to remain. Conversely, 20% of employees feel less inclined to stay, especially if they are dissatisfied with their benefits packages.... One strategy to improve employees' benefits understanding is for employers to offer total compensation statements (see sample). These statements provide the total monetary value of employer-paid benefits."  MORE >>