"[CMS] is publishing this guidance to provide individual market qualified health plan (QHP) issuers with flexibility, if permitted by applicable state authorities, to use modified Federal standard notices of product discontinuation and renewal in connection with the open enrollment period for coverage in the 2026 benefit year, given the significant changes to advance payments of the premium tax credit (APTC) for the 2026 benefit year. In addition, this guidance provides a safe harbor from enforcement by CMS under certain conditions, in connection with the open enrollment period for coverage in the 2026 benefit year, with respect to the requirement to provide at least 90 days' notice of a product discontinuation in the individual market."  MORE >>

"Starting in 2026, employer-provided group health plans, including HDHPs, must cover additional breast cancer screenings (e.g., another mammogram, an MRI or an ultrasound) and pathology evaluations after an initial ACA preventive care screening mammogram if the results indicate that further imaging is needed or to complete the screening process. The services must be covered without cost sharing[.]"  MORE >>

"Passed in 1998, [the Illinois Genetic Information Privacy Act (GIPA)] protects the genetic information and genetic testing results of individuals.... GIPA regulates the collection and use of genetic information in connection with voluntary wellness programs, FMLA certification, and genetic monitoring for workplace hazards. The law also prohibits employers from taking adverse employment actions based on an employee's genetic information."  MORE >>

"The decision to leave Mulready as-is re-enforces ERISA preemption and the corresponding limitations of a state's ability to impact employer-sponsored health plans. However, while this decision preserves an ERISA plan sponsor's control over benefit design and network structure, states will likely continue their pursuit of PBM legislation and regulation." [PCMA v. Mulready, No. 22-6074 (10th Cir. Aug. 15, 2023; cert pet. denied Jun. 30, 2025, No. 23-1213]   MORE >>

"A transit agency thought it had a clear-cut reason to fire an employee under its no-fault attendance policy. But a disputed call-out, followed by a retroactive FMLA approval, now means a jury gets to decide whether the termination was lawful." [Walker v. Southeastern Penn. Transp.  Auth., No. 24-2275 (3d Cir. Jul. 8, 2025)]  MORE >>

"The PBM Reform Act [HR 4317] ... seeks to ban spread-pricing models in [Medicare] and instead move to a more 'transparent' system that the legislators say will more fairly reimburse pharmacies for the services they provide. In addition, the bill would delink PBM compensation from medication costs within Part D, and establish semi-annual reporting that provides further detail on spending, rebates and formulary decisions for plan sponsors and members."  MORE >>

"[Surgical Centers of Excellence (COEs)] have been a familiar concept in the market for several decades.... While this article focuses specifically on surgical COEs, several non-surgical COE concepts are making waves in the market. These programs aren't just buzz -- they're making a measurable difference in quality and cost, and more employers are taking an interest."  MORE >>

"During a health emergency, employees may struggle to manage coverage changes, waiting periods and the fine print of voluntary benefits like critical illness or short-term disability insurance. Employers, HR leaders and benefits consultants must ensure employees are aware of, understand and can easily access available benefits."  MORE >>

"[T]he Tenth Circuit agreed with the Ninth Circuit's ultimate decision in Castillo, which was that attorney's fees are not available under Section 1132(a)(3) as a form of equitable relief. The Tenth Circuit ruled that because ERISA explicitly addresses the availability of fees in Section 1132(g), it is improper to apply other provisions in ERISA, such as Section 1132(a)(3), to award the same relief." [Stark v. Reliance Standard Life Ins. Co., No. 24-6137 (10th Cir. July 8, 2025)]  MORE >>