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Health & Welfare Plans Newsletter

August 14, 2025

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[Guidance Overview]

IRS Proposes Rules to Update Standard for Determining Line of Business for No-Additional-Cost Services, Qualified Employee Discount Exclusions

"The proposed regulations would eliminate use of the business classification system set forth in the Enterprise Standard Industrial Classification (ESIC) Manual and substitute the North American Industry Classification System (NAICS) ... Switching from the ESIC Manual to the NAICS Manual may provide employers ... with greater accuracy in categorizing their lines of businesses to ... increase opportunities for employees to qualify for the taxable income exclusion[.]"  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

DOL Restarts Self-Audit Program for FLSA and FMLA Violations

"Affected employees identified in the self-reported claim will be provided with a PAID Acceptance Letter outlining the violations and the back wages or remedies owed. If the affected employee accepts the settlement terms, they will forfeit their right to further litigation for the specific violations outlined in the letter.... Employees do not have to accept the settlement and can retain their right to civil litigation for the identified violations."  MORE >>

Arthur J. Gallagher & Co.

[Guidance Overview]

California’s New Fertility Coverage Mandate: What Employers Need to Know

"[T]he law applies to certain fully insured medical plans in California that are issued or renewed on or after January 1, 2026.... This mandate does not apply to self-insured plans.... Plans subject to this mandate should expect to see some increase to their medical premiums upon their next renewal."  MORE >>

Woodruff Sawyer

Ninth Circuit Joins Sister Circuits in Applying Effective Vindication Doctrine to Invalidate Health Plan's Arbitration Provision

"[Platt] filed suit against Sodexo, alleging that its imposition of a monthly tobacco surcharge on his employee health insurance premiums violated ERISA.... Sodexo moved to compel arbitration based on a provision that it had unilaterally added to the plan in 2021.... [T]he plan's arbitration provision contained a representative action waiver ... Because this provision precluded Platt from obtaining plan-wide relief explicitly authorized by ERISA, it prevented him from 'effectively vindicating' his rights under ERISA, and thus it was unenforceable." [Platt v. Sodexo, S.A., No. 23-55737 (9th Cir. Aug. 4, 2025)]  MORE >>

Kantor & Kantor

Eleventh Circuit Upholds Lina's Denial of Long-Term Disability Benefits Despite Social Security Award

"The court found no clear error in the district court's determination that LINA's medical and vocational evidence outweighed the claimant's proof of disability under [ERISA]." [Walker v. Life Ins. Co. of N. Amer., No. 24-13066 (11th Cir. Aug. 13, 2025)]  MORE >>

Roberts Disability Law

Employers Project 10% Rise in Health Care Costs for 2026

"The top four factors (listed by the percent of respondents who identified them as primary causes) include ... [1] 31% -- Catastrophic claims (up from 20% last year); [2] 23% -- Specialty/costly prescription drugs (up from 20% last year); [3] 15% -- Utilization due to chronic health conditions (down from 16% last year); [4] 11% -- Medical provider costs (down from 18% last year)."  MORE >>

International Foundation of Employee Benefit Plans [IFEBP]

ICHRAs Are Expanding Employee Access to Health Coverage

"[M]ost employers offering an ICHRA had not previously provided health benefits.... Larger employers are remaining cautious.... ICHRAs offer a model analogous to the retirement system's transition from defined benefit to defined contribution plans."  MORE >>

Employee Benefit Research Institute [EBRI]

Why More Employers Are Turning to ICHRA for Affordable Health Care Benefits

"The flexibility, cost-effectiveness, and potential for increased employee satisfaction make ICHRA a compelling option for the future of health care. Embracing this innovative approach could well position businesses for success in an evolving and expensive health insurance landscape."  MORE >>

Kohrman Jackson & Krantz LLP

Unfunded Retiree Health Care Debt Surpasses Pension Liabilities

"Unfunded retiree health care debt is becoming an unsustainable financial burden for state and local governments, as the price tag for Other Post-Employment Benefits (OPEB) grows larger with medical inflation, while assets set aside to pre-fund these obligations remain low.... [A recent analysis] found that states and large municipalities collectively reported $789 billion in unfunded OPEB liabilities, exceeding the $753 billion in unfunded pension liabilities, as of 2022."  MORE >>

BenefitsPro; registration may be required

Values-Driven Employee Benefits: A How-To Guide

"Unlike market-driven employee benefits, which are designed to match competitors or meet compliance requirements, values-driven benefits serve as a tangible extension of your organization's purpose.... If a company values innovation, it might fund professional development and certifications. If it values community impact, it might offer paid volunteer time. If it values sustainability, it might embed eco-conscious practices into everyday work life."  MORE >>

Nava

Study Finds Medicare Advantage Delivers Better Care Than Fee-for-Service Medicare

"Compared to enrollees in [fee for service Medicare (FFS)], [Medicare Advantage (MA)] beneficiaries were more likely to receive recommended screenings and testing ... MA outperformed FFS on measures of medication adherence ... The new study's findings add to a growing body of evidence that MA's coordinated, value-based approach delivers superior quality and better health outcomes[.]"  MORE >>

AHIP

Benefits in General

Best Practices for ERISA Plan Sponsors and Fiduciaries in a Changing World: Using Insurance Wisely

"[P]oint number one for plan sponsors: take fiduciary liability insurance very seriously, and don't treat it like just another part of the corporate insurance program.... Point number two for plan sponsors is to pro-actively understand the coverage.... Point number three for plan sponsors and fiduciaries is to consider how much control of lawsuits against them that they want to have under their fiduciary liability insurance policies. "  MORE >>

Stephen Rosenberg, The Wagner Law Group

Employee Benefits Jobs

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EPIC RPS

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Press Releases

SageView Advisory Group Enhances Services and Midwest Footprint with Acquisition of Cap Strat

SageView Advisory Group

Hy-Vee Health and Oscar Serve Up a New Era of Employer Healthcare

Oscar

Webinars, Podcasts and Conferences
(Health & Welfare Plans)

2025 Benefits Forum: Benefit Trends for a Resilient Workforce

September 25, 2025 in VA

Williams Mullen

Last Issue's Most Popular Items

The OBBBA Effect: Should We Increase Our Dependent Care FSA Contribution Limit?

Willis Towers Watson

Overview of Nondiscrimination Rules for Health and Welfare Plans

Maynard Nexsen

Agencies Issue FAQs for No Surprises Act and ACA Compliance

Maynard Nexsen

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BenefitsLink® Health & Welfare Plans Newsletter, ISSN no. 1536-9595.

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