"The benefit-related provisions in the law differ from those in the version initially passed by the House ... The HSA-related changes will also be welcomed and should provide added flexibility. Note that [plan] amendments may be needed to take advantage of the changes, depending on how applicable documents are drafted. Employee communication materials will also likely require updating."  MORE >>

"The One Big Beautiful Bill Act (OBBBA) signed into law on July 4, 2025 contains a number of benefits related updates, even if the final version that was signed into law did not include a significant number of benefits provisions that had been included in prior versions.... [T]he omitted provisions may provide a glimpse of benefits changes that we may see in the future."  MORE >>

"The New York State Department of Financial Services (DFS) and the Department of Health (DOH) have recently adopted 'network adequacy' regulations requiring health plans to enhance access to mental health and substance use disorder services. ... [T]he DFS regulation applies to fully insured health insurance plans written in New York (while the mirrored DOH regulations apply to HMOs, including Medicaid managed care plans). These 'network adequacy' regulations do not apply to self-funded plans or fully insured plans issued outside of New York."  MORE >>

"The paid sick leave repeal ... [is] set to go into effect on August 28, 2025 ... [A]ll of its requirements remain in effect in the interim, including the requirement that employees accrue one hour of paid sick leave for every 30 hours worked through August 27, 2025.... For any employer that provided a new paid sick leave benefit only because the law required them to, the company may want to consider whether to walk back or eliminate the benefits earned since May 1st when the law is repealed on August 28th."  MORE >>

"This article addresses the tensions employers face when an employee loses valid work authorization or is discovered to have used false identity documents.... [A] termination of employment with a loss of health plan coverage usually triggers a legal obligation to offer continuation coverage. This can leave employers questioning whether offering COBRA to someone now unlawfully present could violate immigration law.... Employees who lose TPS or other temporary work authorization present a particular challenge."  MORE >>

"The PBM Reform Act [HR 4317] will: [1] Ban 'spread pricing' in Medicaid ... [2] Establish new requirements for PBMs under Medicare Part D ... [3] Promote transparency for both employers and patients in their prescription drug plans, with semi-annual reporting on drug spending, rebates, and formulary determinations. [4] Require [CMS] to define and enforce 'reasonable and relevant' contract terms in Medicare Part D pharmacy contracts and enforce oversight on reported violations."  MORE >>

"Eighty-six percent understood that premiums are the amount paid for health insurance, regardless of using care, and 82 percent understood that the deductible is the amount you have to pay out of pocket before your plan begins to pay for care.... However, there was confusion among enrollees over prescription copays: only about one in four knew that the amount is not the same for all groups of prescriptions. And there was confusion about out-of-pocket maximums."  MORE >>

"Just under half of U.S. adults say it is difficult to afford health care costs, and one in four say they or a family member in their household had problems paying for health care in the past 12 months.... Almost four in ten insured adults under the age of 65 (38%) worry about affording their monthly health insurance premium and large shares of adults with employer-sponsored insurance (ESI) and those with Marketplace coverage rate their insurance as 'fair' or 'poor' when it comes to their monthly premium and to out-of-pocket costs to see a doctor."  MORE >>

"[T]he overall growth of total health care expenditures seems to be slowing, despite a gradual aging of the population driving increased demand for services and the emergence of new drugs and technologies to care for patients.... As we exit the preceding period of record-low inflation, the mismatch of revenue growth and expense growth for providers of health care will result in unprecedented strain for physician groups, hospitals, and health systems."  MORE >>