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Health & Welfare Plans Newsletter
July 21, 2025
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💼 6 New Job Opportunities
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[Guidance Overview]
Regulatory Trend: Safeguarding Mental Health in an AI-Enabled World
"New York is the first state to enact mental health-focused statutory provisions for 'AI Companions,' requiring user disclosures and suicide prevention measures for emotionally interactive AI systems.... [C]hatbots, digital wellness tools, mental health apps or even
productivity assistants with emotionally aware features could fall within the scope of AI Companions depending on how they interact with users[.]" MORE >>
Polsinelli PC
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[Guidance Overview]
The ACA Affordability Determination in 2026
"The 2026 ACA affordability threshold increases to 9.96%. The easiest way to ensure affordability in 2026 is to meet the federal poverty line affordability safe harbor by offering at least one medical plan option (that provides minimum value) for which the monthly employee-share
of the premium for employee-only coverage does not exceed $129.89. Otherwise, employers calculate the affordability threshold under one of the other safe harbor approaches that is based on employee compensation levels." MORE >>
Newfront
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Insurers and Customers Brace for Double Whammy to Obamacare Premiums
"In initial filings, insurers nationally are seeking a median rate increase ... of 15% ... For the 2025 plan year ... the median proposed increase was 7%.... Most insurers are asking for 10% to 20% increases.... [I]nsurers say underlying medical costs --
including the use of expensive obesity drugs -- will add about 8% to premiums for next year. And most insurers are also adding 4% above what they would have charged had the enhanced tax credits been renewed." MORE >>
KFF Health News
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Pharmacy Dynamics and Trends Driving Prescription Drug Use and Cost
"[1] New drugs influencing benefits ... [2] Legislation impacting drug costs ... [3] Vaccine season is approaching ... [4] Maximizing use of biosimilars ... [5] What’s next for GLP-1s?" MORE >>
Brown & Brown, Inc.
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Are Hospital Acquisitions of Physician Practices Anticompetitive?
"[On] average, these mergers led to price increases for hospitals and physicians of 3.3% and 15.1%, respectively, with no discernible effects on quality measures. ... [P]rice increases are larger among transactions with greater scope for foreclosure and recapture. ... [These]
tests offer guidance in predicting where the anticompetitive effects of non-horizontal mergers are likely to be strongest." MORE >>
National Bureau of Economic Research [NBER]; purchase may be required for full document
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AI in Healthcare: Who Pays When AI Fails?
"The healthcare sector is undergoing a significant AI-driven transformation. From clinical decision support and diagnostics to patient triage, claims handling, and predictive analytics, AI offers significant benefits in speed, accuracy, and efficiency. Yet alongside this progress
comes a harder truth: AI is introducing new types of risk -- algorithmic bias, opaque accountability, system error.... While the promise of AI in healthcare is clear, the protection around it still needs work." MORE >>
Willis Towers Watson; registration required for full whitepaper
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Benefits in General |
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[Guidance Overview]
Benefits and Executive Comp Provisions in the One Big Beautiful Bill
"[E]xpanded flexibility for health savings accounts (HSAs) and new restrictions on premium tax credit eligibility ... may reduce the risk of triggering an employer shared responsibility penalty under the [ACA].... Limiting the deduction of excessive remuneration....
Expanding the application of excise tax on excess compensation within tax-exempt organizations." MORE >>
Polsinelli PC
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Seventh Circuit Reverses Ruling That Imposed Personal Liability on Company Principal for Plan Contributions
"The company signed a memorandum of agreement adopting a union collective bargaining agreement and the terms of the Fund's trust agreement. That trust agreement included a personal liability clause providing that 'officers and directors' of signatory employers would
be personally liable for underpayments caused by willful violations of the agreement.... The court emphasized that this presented a textbook factual dispute: the signature in a representative capacity suggested no personal liability, while the clause implied the opposite." [R.R. Maint. & Indus. Health and Welfare Fund v. Mahoney, Nos. 24-2704, 24-2817 (7th Cir. Jul. 17, 2025)] MORE >>
Roberts Disability Law
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Employee Benefits Jobs
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Selected New Discussions |
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Reimbursement of Medical Expenses Payable to Adult Dependent Children
"A client maintains, as part of its health plan, a healthy lifestyles program. This program provides reimbursements to participants and their dependents for vitamins, non-medical nutritional counseling, gym memberships, massage therapy and weight management, among others. The
program's administrative services provider was recently changed and it has been issuing reimbursements of expenses incurred by adult dependent children directly to the children rather than the participant. When questioned about their rationale for this practice, the provider claims that [ACA] regulations require that the reimbursements to such individuals must be made payable to adult dependents instead of to the member participant.
"My understanding is that the ACA mandate merely requires a group health plan to extend coverage to a child until s/he attains age 26. There is no requirement stated in the provisions of the Code, ERISA or the PHSA that was amended by ACA (or their underlying regulations)
requiring that such reimbursements be paid directly to the adult dependent child. As an analogy, for a married couple, if the spouse of a participant incurs medical expenses, the reimbursements are paid to the participant and not to the spouse. Do you agree with my understanding?"
BenefitsLink Message Boards
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Press Releases |
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Principal® Collaborates with FuturePlan to Meet Heightened Demand for Pooled Retirement Plans
Principal Financial Group
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Last Issue's Most Popular Items |
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How Does the One Big Beautiful Bill Impact Your Health & Welfare Plans?
Trucker Huss
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Text of IRS Rev. Proc. 2025-25: Applicable Percentage and Required Contribution Percentage for 2026 (PDF)
Internal Revenue Service [IRS]
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New Reporting Requirements for TPAs, PBMs and Insurers in Indiana
Polsinelli PC
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BenefitsLink® Health & Welfare Plans Newsletter, ISSN no. 1536-9595.
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