"[On] May 30, 2025, the Fifth Circuit granted a rehearing en banc, and vacated the Fifth Circuit's October 30, 2024 panel opinion. As a result, the ... district court's decision from August 24, 2023 continues to bind the Departments pending the Fifth Circuit's en banc decision....

• Q1: How should plans and issuers calculate a QPA for purposes of patient cost sharing, disclosures with an initial payment or notice of denial of payment, and disclosures and submissions required under the Federal IDR process following the Fifth Circuit's order of May 30, 2025 in TMA III? ...
• Q2: How should plans and issuers make disclosures about the QPA to nonparticipating providers, facilities, and providers of air ambulance services with an initial payment or notice of denial of payment, and in a timely manner upon request of the provider or facility? ...
• Q3: What is the premium adjustment percentage for the 2026 plan year? ...
• Q4: What is the maximum out-of-pocket limit for the 2026 plan year?" 

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"COBRA requires only that the plan administrator mail the notice to the qualified beneficiary's last-known address. But courts have applied 'inquiry notice' and 'fiduciary responsibility' theories to impute to plan administrators knowledge that a qualifying event has occurred, and those theories could be extended to a returned election notice when a plan administrator knows that a notice has not been received."  MORE >>

"[T]he City's amended leave law now explicitly requires NYC employers to provide up to 20 hours of paid prenatal leave for eligible employees within a 52-week period and seeks to integrate related paid prenatal leave obligations into the existing ESSTA compliance framework for safe/sick time. The amendments also clarify the available penalties, remedies, and enforcement mechanisms for violations of the paid prenatal leave requirements."  MORE >>

"The PAID program is intended to allow employers to efficiently correct compliance mistakes while ensuring employees receive adequate compensation.... Acceptance into the PAID program is not guaranteed; however, WHD states that if it declines an employer's good faith request to participate in the program, the request will not serve as a basis for future investigation of the identified violations unless WHD has reason to believe that health or safety are at risk."  MORE >>

"his case underscores the limited role of the courts in overseeing the IDR process. In addition to declining to micromanage the implementation of the NSA, other courts have held that providers have no private right of action to enforce IDR awards." [Neurological Surgery Practice of Long Island, PLLC v. HHS, No. 24-1884 (2d Cir. Jul. 22, 2025)]  MORE >>

"Covered entities that have already updated their [Notices of Privacy Practices (NPPs)] to incorporate the 2024 rule's reproductive health provisions should now remove those disclosures and revert to the prior NPP language. The district court's decision likely constitutes a 'material change' under HIPAA and triggers a requirement to redistribute the revised NPP within 60 days.... All other NPP modifications contained in the 2024 rule unrelated to reproductive health remain in effect, and covered entities must comply with these by the February 2026 deadline." [Purl v. HHS, No. 24-0228 (N.D. Tex. Jun. 18, 2025)]  MORE >>

"America's high drug prices are largely self-inflicted. Foreign health systems often refuse to pay for expensive new treatments unless the price comes down. The Trump administration can't reduce America's high drug costs without addressing their domestic underlying causes: laws and regulations that force insurers and government programs to cover a wide array of drugs and new therapies without regard to value for money."  MORE >>

"[As] many in the PEO space have discovered, simply offering benefits alongside HR outsourcing is not enough. Employees increasingly expect intuitive, digital-first experiences. Employees appreciate having the ability to compare their benefit plans and access support from any location through their mobile devices. In this context, technology stands out as a strategic differentiator."  MORE >>

"Fidelity Investments' Retiree Health Care Cost Estimate finds that an average 65-year-old couple today will spend upwards of $172,500 on healthcare costs in retirement, representing a 4% increase compared to last year in an overall rising trajectory since Fidelity's inaugural $80,000 estimate in 2002.... [J]ust 23% of Americans are contributing to an HSA to prepare for healthcare costs in retirement, and only three-in-10 are investing their HSA assets."  MORE >>