"[1] The One Big Beautiful Bill Act ... [2] New York City Paid Prenatal Leave ... [3] [HHS] Marketplace Integrity and Affordability Final Rule ... [4] [IRS] Revenue Procedure 2025-25: [ACA] Affordability ... [5] IRS Revenue Procedure 2025-26: Employer Shared Responsibility Payments (ESRPs).... Many of [these changes] provide plan sponsors with increased flexibility to optimize benefits offered to their eligible employees and their dependents.... Plan sponsors should review their offerings now to implement any changes before the beginning of the 2026 plan year."  MORE >>

22 pages. "The second quarter witnessed a flurry of state activity, including significant legislation affecting pharmacy benefit managers (PBMs).... On the paid sick and safe leave (PSSL) front, a state supreme court affirmed Missouri's new mandate, but the legislature later repealed it. New York City adopted a paid prenatal leave mandate ... Insurance coverage of fertility services was the focus in California, Georgia and Nevada ... Three states addressed telehealth reimbursement parity.... Alabama and Tennessee created benefit accounts for self-employed workers."  MORE >>

"San Francisco recently released the required 2026 expenditure rates for its Health Care Security Ordinance (HCSO). The HCSO requires covered employers to spend a certain dollar amount on healthcare (i.e. medical, dental, vision, prescription drugs) for covered employees."  MORE >>

"[FAQs Part 71] discusses how plans and issuers should 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 Independent Dispute Resolution (IDR) process. It also addresses limitations on cost-sharing under the [ACA]."  MORE >>

"In litigation challenging a health plan's tobacco surcharge under [ERISA], the Ninth Circuit held that an employer/plan sponsor could not unilaterally add an arbitration provision to the plan without obtaining a participant's (or plan's) consent. Because the employer could not show that the participant had agreed to arbitrate certain of the ERISA claims at issue, the employer could not compel arbitration of those claims." [Platt v. Sodexo, S.A., No. 23-55737 (9th Cir. Aug. 4, 2025)]  MORE >>

"The court found the law's language to be clear: 'Exempt employees' includes all those exempt from overtime rules, including outside salespeople. The court rejected the argument that the term 'exempt' should be limited to executive, administrative, or professional employees." [Hirdman v. Charter Communications, No. D084304 (Cal. Ct. App. Aug. 4, 2025)]  MORE >>

"Consultants can help clients respond through several strategies: ... [1] Encourage employers to work with pharmacy benefit managers (PBMs) that offer reliable delivery services and virtual consultations.... [2] Make sure your clients' benefit designs include virtual pharmacist consultations to bridge access gaps. [3] Advocate for biosimilars ... [4] Incorporate pharmacy-based services like immunizations and screenings into employer wellness offerings ... [5] Use data to identify risk areas."  MORE >>

45 pages. "[G]iven the ongoing acceleration in cost trend ... 51% say it's likely or very likely they will shift cost in 2026, compared to 45% that said they were likely to do so in 2025.... Nearly one in 10 employers offer telemedicine services to employees who are not eligible for the medical plan ... as a way to assist low-earners with affordable access to care.... High-performance networks and alternative health plans allow employers to offer more affordable options."  MORE >>

"[D]elivering retiree healthcare benefits through the individual market presents a significant opportunity for institutions to reduce costs and improve retiree satisfaction. However, it's imperative to allocate sufficient resources to a communication and change management strategy that anticipates and addresses retiree and stakeholder concerns"  MORE >>

"As the sponsor of a self-insured plan, your company is generally free to define the term 'domestic partner' as it chooses and to determine what documentation will be required as evidence of the domestic partner relationship.... For purposes of tax treatment of the benefits provided, plans may require an affidavit or similar document indicating whether a domestic partner enrolled for coverage qualifies as a tax dependent and imposing an affirmative obligation on the employee to notify the employer of any changes."  MORE >>

"Although some of the OBBB's benefits provisions simply make permanent existing temporary suspensions in the Code, others will provide opportunities for enhancement or expansion of employee benefit programs.... Conversely, the OBBB also presents some challenges for employers, who must now revise how they monitor certain executive compensation amounts, and make operational changes to their payroll administration systems for certain wages such as overtime pay."  MORE >>