"[C]ertain events that occur during the year can trigger a special enrollment period (SEP), when a person may be able to newly enroll in a marketplace plan or change to a different plan outside of the open enrollment period. This chart lists the various events that can trigger an SEP in the marketplace, the timing for when people can access these SEPs, and when coverage through a particular SEP becomes effective. "  MORE >>

"For 2025, with the Inflation Reduction Act lowering the out-of-pocket maximum to $2,000 (from $8,000 in 2024), many employer prescription drug plans -- and especially those with High Deductible Health Plans -- may find that their plans are no longer creditable.... [N]ew changes for 2026 may also impact these notices."  MORE >>

"With the passage of House Bill 567, the mandatory Earned Paid Sick Time (EPST) law is nearing its repeal, effective August 28, 2025.... Employers must navigate not just a compliance pivot, but also a legal gray zone without official guidance or precedent.... So, what should employers do now, and how do you handle the sick leave your employees have already earned?"  MORE >>

"Employers may wish to ensure that their notice requirements are clearly communicated and consistently enforced. It may be wise to document and align any unwritten customs or practices with the official policy to avoid confusion and legal challenges.... With regard to unforeseen intermittent leave, it may be wise to consider the number of leave days on an FMLA certification as an estimate, and not an absolute limit.... Employers have the ability to confirm that leave was actually used for an FMLA-covered purpose." [Jackson v. USPS, No. 25-0231 (6th Cir. Aug. 21, 2025)]  MORE >>

"the Sixth Circuit has ruled that an employee on FMLA leave may be discharged based on the employer's honest belief that the employee has lied about the need for such leave. The FMLA protects eligible employees from retaliation or interference when taking qualified leave, but it does not insulate employees from discipline for fraudulent or dishonest conduct. Employers may investigate suspected FMLA abuse, and, if fraud is substantiated, take appropriate action." [Porter v. Jackson Township Highway Dept., No. 24-3524 (6th Cir. Jun. 24, 2025)]  MORE >>

"This case arose from Caremark's failure to comply with a change in Medicare's policies intended to curtail opaque pricing practices.... This case and Judge Goldberg's judgment further demonstrate to PBMs the consequences of failing to keep up with changes in the law and the increased scrutiny PBMs are now facing from federal agencies." [U.S. ex rel Behnke v. CVS Caremark Corp, No. 14-0824 (E.D. Penn. Aug. 19, 2025)]  MORE >>

"To date, courts have rejected constitutional challenges to the law, preserving the law's fundamental protection against surprise out-of-network bills. But other lawsuits have taken a toll as providers have largely been successful in blocking key rules and guidance to implement the IDR process.... Most recently, payers have turned to the courts to sue providers and IDR middlemen, alleging widespread abuse of the IDR process by several private equity-backed firms that initiate many IDR disputes."  MORE >>

"Wegovy has now received FDA approval for the treatment of metabolic dysfunction-associated steatohepatitis (MASH) in adults with moderate-to-advanced fibrosis.... The growing GLP-1 approval pipeline has significant implications for employers in terms of cost, coverage, and employee access. Throughout the end of 2026, new indications across a broad range of clinical applications are expected that employers should be aware of[.]"  MORE >>

"[1] Spend smarter by targeting root causes of cost ... [2] Design benefits based on actual needs vs. assumptions ... [3] Go beyond financial literacy to Financial Care ... [4] Deliver flexibility, with guidance ... [5] Tie benefits to organizational purpose."  MORE >>