"The health IT arm of [HHS] finalized a rule ... that federal leaders say will remove red tape and enable faster prior authorization and real-time prescription benefit checks. The policy changes also will improve electronic prescribing standards, the agency said.... [A] fact sheet outlin[es] the major updates in the rule."  MORE >>

"Starting in 2026 ... [t]he 'No-Offer' Penalty jumps from $2,900 to $3,340 per full-time employee. This kicks in when you don't offer health coverage to at least 95% of your full-time workers and someone ends up getting subsidized coverage through the marketplace. The 'Affordability' Penalty shoots up from $4,350 to $5,010 per affected employee. You'll face this one when your coverage doesn't meet minimum value standards or costs more than 9.96% of an employee's household income (up from 9.02% in 2025)."  MORE >>

"Employees often are denied LTD benefits if they did not receive STD benefits during the LTD policy's exhaustion period, so the importance of applying for both PFML and STD benefits when a need for medical leave arises cannot be overstated.... [If] an employee applies for PFML and STD benefits at different times, it may result in the employee receiving PFML and STD benefits consecutively, rather than concurrently, which in turn may lead to requests for longer leaves of absence from work.... Another way to simplify the medical leave benefit process is to offer combination PFML-STD policies that provide one medical income replacement benefit to employees that equals or exceeds the state-required PFML benefit."  MORE >>

"Effective January 1, 2026 ... [e]mployers with 15 or more employees will be required to provide at least 72 hours of paid sick leave per year, while employers with fewer than 15 employees must provide 48 hours per year. The amendment also accelerates the rate at which employees accrue paid sick leave."  MORE >>

"With the new $30 cap on what health care providers can charge for completing FMLA related paperwork, more employees may be encouraged to initiate the certification process. Cost has potentially been a barrier, especially for lower wage workers or employees already facing financial strain while preparing to take unpaid leave. A predictable and reduced fee can make employees more willing to get the paperwork completed."  MORE >>

"The 10th Circuit's position stands for now ... It will have a ripple effect on other states even though it is the law only for states within the 10th Circuit. Presumably, it means that ERISA does not preempt state rate/pricing mechanisms, but ERISA does preempt state level regulation of plan design or coverage requirements." [PCMA v. Mulready, No. 22-6074 (10th Cir. Aug. 15, 2023; cert pet. denied Jun. 30, 2025, No. 23-1213]   MORE >>

"Minnesota Life later denied the beneficiaries' claim for the group policy benefit, asserting that DiNicola had lost eligibility when she resigned and that the previous confirmations of coverage were clerical errors.... The court found that Minnesota Life acted as a fiduciary when it repeatedly communicated to DiNicola that her group policy coverage remained intact.... Similarly, the court found that plaintiffs plausibly alleged an equitable estoppel claim under ERISA." [Fleming v. Minnesota Life Insurance Co.., No. 23-2558 (E.D. Pa. Jul. 29, 2025)]  MORE >>

"Fifty-four percent of adults covered by private plans were told by their insurer that their medication was no longer covered ... [A]lmost half of such adults said their plan referred them to a third party to help them obtain the medications ... Such [alternative funding programs (AFPs)] save employer-sponsored health plans money ... [but] can also result in delays compared to straightforward insurance coverage.... Nearly all adults -- 92% -- said they were negatively impacted by the delays.... Almost half of patients said that ultimately their medication was once again covered through their health insurance plan."  MORE >>

18 pages. "These proposed regulations would replace a business classification system that has not been updated since 1974 with a much more current classification system that is updated every five years. Under these proposed regulations, the application of the no-additional-cost benefit and employee discount exclusions from employee income under section 132(a)(1) and [2] would be determined under a classification system that more accurately reflects current economic activity than the system used under the existing regulations, thereby reducing burden in applying the exclusions from income under section 132(a)(1) and (2)."  MORE >>

"The court held that while an employer may amend the plan itself, it cannot bind participants to arbitrate ERISA claims without their consent. The decision reaffirms key participant protections under ERISA and underscores limits on employer-driven arbitration mandates." [Platt v. Sodexo, S.A., No. 23-55737 (9th Cir. Aug. 4, 2025)]  MORE >>

"The court held that while Live Nation validly bound its 401(k) plan to arbitration of ERISA claims through a plan amendment, the plaintiffs -- former plan participants -- must be permitted to assert unconscionability defenses under federal common law. The court remanded the case for further proceedings on those defenses." [Avecilla v. Live Nation Entertainment, Inc., No. 23-55725 (9th Cir. Aug. 4, 2025; unpub.)]  MORE >>

"Most ERISA class actions, and in fact most ERISA cases, have a few outcome determinative issues in them that will determine liability ... There is no reason ... to litigate all of the other issues in that type of a case all the way through discovery and to summary judgment motions before that discrete issue -- one that might moot everything else -- is decided.... [P]lan fiduciaries and their lawyers should affirmatively and constantly pursue these types of opportunities to reduce the scale of the litigation to solely the outcome determinative issues that they have identified, before the case is ever allowed to expand into broad discovery and litigation of the remainder of the case."  MORE >>