"With the enactment of AB 116, large, fully insured medical plans that renew between July 1, 2025 and December 1, 2025 ... [as well as those] renewing January 1 through June 1 will be required to comply with the new mandate as of their plan renewal in 2026. Employers in the small group market will not have to consider offering an infertility rider that mirrors coverage in the large group market until their plan's renewal on or after January 1, 2026."  MORE >>

"Health insurers must provide speedier responses to prior authorization requests for certain medical treatments and services, under a bill that went into law on [July 21] ... The measure, Senate Bill 133, requires insurers to notify patients within 72 hours whether the requested services are authorized in cases when requests are sent by fax or by other routine means. In cases of expedited requests, the insurer must provide answers within 24 hours[.]"  MORE >>

"As inferior officers, the Secretary of HHS also has the power to remove USPSTF members at will and 'review and block Task Force recommendations before they take effect.' ... Thus, the USPSTF 'A' and 'B' recommendations should now be viewed as recommendations made to the Secretary of HHS, who has the final say in whether such recommendations are truly requirements for group health plans." [Kennedy v. Braidwood Management, Inc., No. 24-316 (S. Ct. Jun. 27, 2025)]   MORE >>

"The Braidwood Management case answered important constitutional questions and upheld the validity of the Task Force's structure -- but why should employers and plan sponsors care? [1] Free preventive services are here to stay -- for now.... [2] Task Force could be subject to greater political influence." [Kennedy v. Braidwood Management, Inc., No. 24-316 (S. Ct. Jun. 27, 2025)]  MORE >>

"A recent First Circuit decision ... illustrates how ERISA preemption of state law protects employers where a former employee asserts state law claims alleging improper termination of employment to avoid paying severance benefits. This post describes the benefits of ERISA preemption, provides an overview of the First Circuit decision, and highlights key aspects courts look to in determining whether a severance program is an ERISA plan." [Orabona v. Santander Bank, N.A., No. 24-1905 (1st Cir. Jun. 16, 2025)]  MORE >>

"Providers bringing the suit maintain that the healthcare technology solutions company MultiPlan and roughly 700 health plans conspired to suppress reimbursement for out-of-network services over a decade ... In addition to highlighting ongoing strain in payer-provider relations, the case illustrates providers’ concerns about payers’ use of algorithms to make coverage and payment determinations." [In re MultiPlan Health Insurance Provider Litigation, No. 24-6795 (N.D. Ill. Jun. 3, 2025)]   MORE >>

"A new state law regulating certain pharmaceutical companies is partially and temporarily blocked -- but only for the Iowa businesses that signed onto a lawsuit ... The law in question was designed to help rural pharmacies and address prescription drug costs by adding regulations on pharmacy benefit managers, or PBMs[.]" [Iowa Assoc. of Bus. and Ind. v. Ommen, No. 25-0211 (S.D. Iowa Jul. 21, 2025)]  MORE >>

"Many 2026 rate filings were submitted before key federal policies were finalized, requiring insurers to price coverage amid higher-than-usual uncertainty. This lack of clarity around enrollment, utilization, and cost impacts may have led to higher risk margins among some insurers."  MORE >>

"Open enrollment can be a challenge ... This quick FAQ guide helps you confidently answer the most common employee questions -- without getting buried in benefits jargon."  MORE >>

26 pages. "This report sets forth ... the applicable adjustments to 2023 benefit year risk adjustment State transfers based on the 2023 benefit year HHS-RADV results.... These HHS-RADV adjustment amounts will be collected (if an HHS-RADV charge amount is owed) in the Fall of 2025 and subsequently paid (if an HHS-RADV payment amount is due), pending collections. Issuers will also receive new issuer-specific transfer reports for the 2023 benefit year[.]'

[Also available: Appendix A: Issuer-Specific 2023 HHS-RADV Adjustments to 2023 Risk Adjustment State Transfers for Non-Merged Market States (XLSX); Appendix B: Issuer-Specific 2023 HHS-RADV Adjustments to 2023 Risk Adjustment State Transfers for Merged Market States (XLSX); Appendix C: HHS-Operated Risk Adjustment Program State-Specific Data (XLSX)]  MORE >>

"This synopsis highlights key connections among health coverage sources for the under-65 population. Most individuals in this age group obtain coverage through an employer, Medicaid or the Children's Health Insurance Program (CHIP), the individual market, or remain uninsured. These sources interact with one another and with the uninsured population. Individuals often move between these sources due to changes in employment, income, family status, or other circumstances."  MORE >>

"Tax-exempt organizations with employees who earn $1 million or more may have increased tax liability ... particularly due to severance agreements. However, beginning in 2026, organizations will no longer need to track the top highest paid employees.... If individuals lose ACA premium tax credits, they may instead seek enrollment in employer sponsored plans that could increase plan costs ... Bronze and catastrophic plans are treated as HDHPs regardless of their deductible levels and out-of-pocket maximums."  MORE >>

"According to IRS records, 25,386 employees separated, took a DRP offer, or used some other incentive to leave. Another 294 employees were sent termination notices due to RIF actions. These departures represent 25 percent of the IRS's [total] workforce ... [A]pproximately 27 percent of tax examiners separated, while 26 percent of revenue agents separated.... Business Units affected by the separations [include]: 569 employees, or 25%, of the Tax Exempt & Government Entities (TE/GE) unit."  MORE >>

Video of July 21 hearing. Opening Statement by Chairman Rick Allen (R-GA), and witness testimony from: [1] Mr. Lars Golumbic, Groom Law Group; [2] Mr. Andy Banducci, ERISA Industry Committee; [3] Ali Khawar, FCP, LLC; and [4] Mr. Jim Bonham, Employee Stock Ownership Association.  MORE >>