Updated Jul. 23, 2025. "The HHS risk adjustment methodology for the 2025 benefit year is described in the HHS Notice of Benefit and Payment Parameters for 2025 final rule[.]' [Also available: Technical Details (XLSX); 2025 Benefit Year Risk Adjustment: SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP)]

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"CLEA and CAPF merged their long-term care plans to form the NPFBA. CLEA and CAPF appoint the trustees responsible for administering the NPFBA LTC Plan.... [T]he Department is of the view that the NPFBA LTC Plan is not an employee welfare benefit plan within the meaning of section 3(1) of ERISA. Because CAPF and CLEA individually are not employee organizations within the meaning of section 3(4) of ERISA, they are likewise not jointly an employee organization for the same reasons."  MORE >>

"Employers should review the required employee contribution for 2026 coverage if they plan to meet the ACA’s affordability limit under the applicable safe harbor. For the many plans using the FPL affordability safe harbor, the considerations differ for calendar- and non-calendar-year plans."  MORE >>

"Rev. Proc. 2025-25 ... set the affordability threshold for employers in 2026. In order to avoid a potential section 4980H(b) penalty an employer must make sure one of its plans provides minimum value and is offered at an affordable price.... Rev. Proc. 2025-26 ... set the penalty amounts for section 4980H(a) and 4980H(b) penalties for 2026.... As many employers have discovered, the IRS is serious about its enforcement of the section 4980H penalties."  MORE >>

"While the trend of states and local jurisdictions adopting paid leave laws has slowed, it has not stopped.... [S]tate and local jurisdictions that already have paid laws in place are now amending their paid leave laws, generally, to expand the requirements and provide greater benefits to employees."  MORE >>

"Although the leave entitlement for employees remains the same, the Rules add additional obligations for New York City employers. Employers must maintain a written paid prenatal leave policy that complies with the Rules and are required to distribute the policy to employees at the time of hire, within 14 days of the effective date of any changes to the policy, and upon request."  MORE >>

"Key points about the FMLA's notice requirements that the Third Circuit noted include ... [1] Employees do not need to expressly mention the FMLA or use any specific language.... [2] The employee must provide enough detail to alert the employer that the absence may be for an FMLA-qualifying reason.... [3] [N]otice must be given 'as soon as practicable under the facts and circumstances of the particular case.' " [Walker v. Southeastern Penn. Transp. Auth., No. 24-2275 (3d Cir. Jul. 8, 2025)]  MORE >>

"Two City of Chicago employees sued under GINA, claiming the City's wellness program improperly requested genetic information from them and their spouses. But a federal judge granted summary judgment for the City, finding that neither plaintiff provided evidence the City ever acquired genetic information -- such as family medical history or genetic test results -- as defined by the statute. If your organization offers wellness incentives, this decision is a valuable GINA 101." [Burris v. City of Chicago, No. 20-0420 (N.D. Ill. Jul. 7, 2025)]  MORE >>

"By denying review of the Mulready decision, the Supreme Court fostered uncertainty that is resulting in nationwide ramifications.... [A]dvocates against PBM regulation have already challenged PBM laws in Minnesota, Tennessee, Iowa, Oklahoma and Arkansas ... Similar to Rutledge, the outcome of these lawsuits will have significant ripple effects across the country and may influence broader discussions in Congress."  MORE >>

14 pages. "[D]rug companies are now advertising a drug and linking a patient to a doctor -- ostensibly chosen by the drug company -- who can write a prescription for it.... This report reveals new findings about: [1] the volume of patients who have engaged in this DTC telehealth arrangement and their prescription outcomes; [2] the exposure and exchange of troves of patient data under these contracts; [3] the financial relationship between Pfizer/Eli Lilly and their chosen telehealth companies; [4] the business model used to funnel patients to specific prescribers; [5] the nature of the patient consultations; and [6] the promotional activities by Pfizer/Eli Lilly. "  MORE >>

11 pages. "This whitepaper provides a preliminary view into how the individual market risk pool is shifting in 2025 following the Medicaid redetermination period in 2023-2024, sizable historical market growth, and other recent enrollment dynamics. Early results point to a notable increase in market risk for 2025, with demographic normalized relative risk rising over 8.3% and 8.0% when comparing 2023 and 2024 to 2025 for the January-April period. "  MORE >>

"As employers increasingly focus on in-person office mandates, reimbursements for relocation expenses have once again become a key component of attracting top talent. If not carefully structured, however, such expense reimbursements may inadvertently trigger significant adverse tax consequences under Section 409A of the Internal Revenue Code."  MORE >>

"Lars Golumbic, principal at Groom Law Group, testified that ... his firm found evidence of collusion between EBSA and plaintiff attorneys, in which trial lawyers were able to receive case information from [EBSA] ... Others expressed concerns over the length of EBSA's investigations and its approach in probing plan sponsors.... ERIC members have also complained of a lack of responsiveness by [EBSA] and variations in modes of operation depending on EBSA's regional offices."  MORE >>