"The 'sledgehammer' penalty applies when an ALE fails to offer Minimum Essential Coverage (MEC) to at least 95% of its Full-Time Equivalent employees (FTEs) as defined by the ACA in any given calendar month. The penalty is $278.33 per month ($3,340 per year) and is multiplied by all FTEs (minus the first 30).... Coverage is considered affordable as per the Section 4980H(b) 'tack hammer' penalty if the required employee contribution satisfies at least one of the three safe harbors. The 2026 'tack hammer' penalty is levied at $417.50 per month ($5,010 per year) for each applicable FTE."  MORE >>

"[P]lan sponsors should consider the following measures ... [1] Reevaluate dependent care FSAs.... [2] Consider retroactively or prospectively reinstating first-dollar telehealth and other remote-care service coverage under HDHPs.... [3] Identify whether to adopt or further explore [direct primary care] arrangements.... [4] Review current or potential employer-provided childcare programs in light of expanded tax credits.... [5] Evaluate and make any required updates to plan documents in light of the OBBBA and any changes adopted."  MORE >>

"Illinois House Bill 5258 ... [requires] that insurers extend coverage to certain parents and stepparents of an insured individual when a plan provides dependent coverage. This new requirement applies to health insurance policies issued, amended, delivered, or renewed in Illinois on or after January 1, 2026."  MORE >>

"DCWP's amended rules do not create a new leave of absence, but rather incorporate by reference the New York State Paid Prenatal Leave Law, which took effect on January 1, 2025.... For each pay period that an employee uses paid prenatal leave, NYC employers must inform the employee of the amount of paid prenatal leave that was taken in that pay period and the remaining balance of paid prenatal leave available for use in the 52-week period."  MORE >>

"[T]he Sixth Circuit affirmed the dismissal of fiduciary breach claims under ERISA brought by a tribal employee welfare plan against its third-party administrator, Blue Cross. While the Court acknowledged that ERISA fiduciary duties encompass efforts to pursue cost-saving Medicare-Like Rate (MLR) discounts, it ultimately held that the Tribe's claims were untimely under ERISA's statute of limitations." [Grand Traverse Band of Ottawa & Chippewa Indians v. Blue Cross Blue Shield of Michigan, No. 24-1367 (6th Cir. Jul. 28, 2025)]  MORE >>

"A federal judge temporarily blocked ... Arkansas' first-in-the-nation law that would have prohibited pharmacy benefit managers from owning pharmacies in the state.... The law, [Judge Miller] wrote, 'appears to overtly discriminate against plaintiffs as out of state companies and the state has failed to show that it has no other means to advance its interests.' " [Express Scripts, Inc. v. Arkansas State Board of Pharmacy, No. 25-0520, 25-0524 (E.D. Ark. Jul. 28, 2025)]  MORE >>

"[Companies] are exploring alternative benefit design options including: [1] Limiting eligibility to a higher BMI ... [2] Using an obesity or cardiometabolic vendor to prescribe and manage drugs ... [3] Subsidizing a portion of drug costs through vendors like Rx Save Card ... [4] Promoting direct-to-consumer (DTC) channels like Lilly Direct and NovoCare."  MORE >>

"As of January 1, 2024, 38.8 million people were enrolled in HSA-eligible health plans, an increase from 32.1 million in 2019. They accounted for 17.9% of the total commercial health plan enrollment, including group health plans and individual health insurance, compared to 15% of the total commercial enrollment in 2019. Large-group coverage accounted for the majority of HSA-eligible health plan enrollment."  MORE >>

"The settlement involved a ransomware attack that affected the electronic protected health information (ePHI) of nearly 24,900 individuals. The CE/health provider must pay $250,000 and comply with a two-year corrective action plan."  MORE >>

"In the event multiple entities are in the picture, a Related Employer analysis must consider every possible pair of entities until all two-employer Groups are identified.... With little or no notice, a subsidiary employer may find itself outside of a Controlled Group ... This may create compliance hassles not only for affected retirement plans, which must re-structure formally to recognize the new arrangement, but also for health and welfare benefits ... Fortunately for retirement plans, the applicable regulations afford a little time to the affected employers to address the effects of a change in Group status, but there is no such transition period for health and welfare plans."  MORE >>