"Beginning with the 2026 plan year, the term EHB will not include 'specified sex-trait modification procedures.' The final regulations contain a definition of 'specified sex-trait modification procedures.' HHS explains that this revision does not prohibit group health plans from voluntarily covering specified sex-trait modification procedures as non-EHB coverage when doing so is consistent with applicable state law."  MORE >>

"The budget reconciliation bill signed on July 4, 2025, removes the sunset date on the employer exclusion for employee student loan repayment assistance, making the exclusion permanent. Further, the bill calls for the $5,250 annual cap on excludable payments to adjust with inflation moving forward, beginning with taxable year 2026. The employer exclusion changes come amid a revamp to student loan repayment assistance programs."  MORE >>

"CMS proposes a streamlined three-step process for adding telehealth services, removing the 'provisional' label and reducing administrative burden. CMS recommends adding several behavioral and specialty services to the telehealth list, while removing or declining others that don't meet statutory criteria. Proposed changes would lift visit frequency limits and allow direct supervision via video for most services, expanding access and easing compliance."  MORE >>

"[T]hese city-level rules impose additional obligations on employers that exceed those required by New York State law and require immediate action by businesses in the Big Apple.... The new rules ... [require] that NYC employers: [1] Institute and distribute a written policy to employees ... [2] Notify employees of their outstanding prenatal leave balance in writing ... [3] Keep records of each instance of paid prenatal leave used[.]"  MORE >>

"This case is a powerful reminder that ERISA plan administrators must strictly comply with procedural requirements when denying benefits. Failure to cite specific plan terms and offer meaningful explanations during the claims process can result in the invalidation of claim denials -- even when the plan grants discretionary authority to the administrator."[Solis v. T-Mobile US, Inc., No. 24-2412 (9th Cir. July 15, 2025; unpub.)]  MORE >>

"The Federal District Court of Connecticut ruled that an implied private right of action to enforce arbitration decisions exists under the No Surprises Rules. The Fifth Circuit ruled that no implied private right of action to enforce arbitration decisions exists under the No Surprises Rules." [Guardian Flight, LLC v. Aetna Life Ins. Co., No. 24-0680 (D. Conn. May 14, 2025); Edwards v. Guardian Life Ins. of Am., No. 24-60381 (5th Cir. June 20, 2025)]  MORE >>

"In making the determination of whether an absence is covered by the FMLA, employers must recognize that the medical certification only represents the health care provider's 'best estimate' of the frequency and duration of the flare-ups that could cause future intermittent absences. Employers should consider whether the absence in question was 'not so far in excess' of the frequency or duration stated in the certification so as to retain FMLA protection." [Davis v. Illinois Dept. of Human Serv., No. 22-2118 (7th Cir. May 14, 2025)]   MORE >>

"Because under the [ACA], part of the Task Force's recommendations forms the basis of a portion of the ACA's requirement on private health plans and insurers to cover certain preventive services without cost sharing (i.e., out-of-pocket costs), the decision has the effect of preserving those coverage requirements based on Task Force recommendations.... This Sidebar provides an overview of the relevant background and the Supreme Court's decision and highlights certain considerations for Congress." [LSB11341 Jul. 16, 2025] [Kennedy v. Braidwood Management, Inc., No. 24-316 (S. Ct. Jun. 27, 2025)]  MORE >>

"For the fourth year, health plan actuaries ... anticipate medical cost trends for the Group and Individual markets to remain elevated. Based on their input, [PwC is] projecting the medical cost trend in 2026 to remain at 8.5% for the Group market and 7.5% for the Individual market, the same levels as 2025. Pharmacy cost trend was 2.5 points higher than medical trend, reinforcing the urgency of managing pharma care."  MORE >>

"Of self-funded employers surveyed, 37% cover GLP-1s for weight loss, with larger employers being more likely to cover them.... Of self-funded employers currently covering GLP-1s for weight-loss, 31% are considering stopping coverage or unsure about continuing coverage in the next 12-24 months.... 71% of employers surveyed are actively exploring, or open to considering, alternative access arrangements such as Direct-to-Consumer programs for their members. 29% are unlikely to consider or unsure about alternative access arrangements."  MORE >>

"[1] There are two distinct types of compounding pharmacies.... [2] GLP-1 supply shortages opened the door for compounding pharmacies and outsourcing facilities.... [3] The FDA has identified areas of concern for compounded GLP-1 products.... [4] Resolution of shortages, FDA enforcement of restrictions, and growing litigation may limit compounding of GLP-1s in the future.... [5] The market is evolving as the compounding supply becomes limited.... [6] There are several potential pathways for patients losing access to compounded GLP-1s. "  MORE >>

"Under general tax principles, the value of employer-provided clothing is a taxable benefit unless the clothing qualifies for an exclusion such as those for de minimis or working condition fringe benefits. The de minimis fringe benefit exclusion may apply to individual items of clothing, like T-shirts, but that exclusion is unlikely to apply when a uniform is provided to a readily identifiable group of employees."  MORE >>

"[I]ndividuals and businesses in parts of New Mexico affected by severe storms, flooding, and landslides that began on June 23, 2025 ... now have until Feb. 2, 2026, to file various federal individual and business tax returns and make tax payments.... [I]ndividuals and households residing or having a business in Chaves, Lincoln, Otero, and Valencia counties qualify for tax relief."  MORE >>

"The OBBBA contains a number of provisions that impact employee benefit matters, including changes to: [1] controlled group application to the limits to deductibility of certain compensation in excess of $1 million, [2] health savings accounts, [3] dependent care assistance plans, [4] 529 savings accounts, [5] ABLE accounts, [6] new Trump savings accounts, [7] transportation fringe benefits, [8] employer payments of students loans, [9] paid family and medical leave credit for the employer, [10] moving expenses and [11] Federal student loan changes[.]"  MORE >>

Video of July 17 hearing, with testimony by: [1] Mrs. Patrice Onwuka, Center for Economic Opportunity; [2] Ms. Kim Kavin, Imagine Media LLC; [3] Mr. Kev Coleman, Paragon Health Institute; [4] Mr. Timothy J. Driscoll, International Union of Bricklayers and Allied Craftworkers; and [5] Ms. Karen Friedman, Pension Rights Center.  MORE >>