"After making the initial premium payment, qualified beneficiaries must make the subsequent premium payments by the end of a 30-day grace period for each month of coverage. If there is an insignificant shortfall in the premium amount paid, the plan generally must provide a notice of deficiency and a 30-day period for the qualified beneficiary to pay the remaining balance."  MORE >>

"[CMS] is working to expand access to catastrophic health coverage in the Federally-facilitated Exchange (FFE) through additional hardship exemption guidance, specifically designed to help consumers access coverage as a result of the premium increases anticipated for the 2026 plan year. This guidance describes circumstances that will support a hardship exemption for individuals who find themselves ineligible for advance payments of the premium tax credit (APTC) or cost-sharing reductions (CSRs) due to their projected annual household incomes, enabling access to more affordable, catastrophic coverage."  MORE >>

"When an employer receives a MLR rebate check, they will need to consider if any portion of the rebate is considered 'plan assets' under [ERISA]. If employees contributed to the total premium, then a portion of the MLR rebate will be considered to be an ERISA plan asset and can only be used to benefit those participants, not the employer."  MORE >>

"[W]orking families should carefully consider choosing a dependent care FSA instead of taking the tax credit, based on the 2026 increase in allowed FSA contributions from $5,000 to $7,500 (or from $2,500 to $3,750 if an employee is married but filing separately).... [E]mployers [should] consider taking steps to adjust their dependent care FSAs to ensure they clear the 55% discrimination test, and that they clearly communicate the options that non-highly compensated employees have in choosing between the FSA or the tax credit."  MORE >>

"Where the Act ... is confusing is in determining whether the employer must pay the employees for the 10 days of leave or must merely allow an employee to take the time off (and/or use any accrued paid leave).... Section 3 of the Act states that the Act is 'intended to provide time off with pay' to allow employees in the state to donate blood or an organ. But while the intent may be stated, the actual language of the Act does not actually accomplish that intent."  MORE >>

"At issue in the case were the MDOL's rules related to premiums and private plan substitutions. Specifically, the MDOL's rules delayed an employer's ability to apply for approval of a private plan until after April 1, 2025.... Ultimately, the court ... found that the MDOL's rules reasonably implemented the Act and that nothing in the statute contemplates refunds for employers that eventually obtain an exemption." [Maine State Chamber of Commerce v. Department of Labor, No. 2025 ME 82 (Maine Aug. 26, 2025)]  MORE >>

"[R]esearch suggests such medications must be used indefinitely to maintain weight loss and related health benefits. But with list prices of roughly $1,000 a month, public and private payers are struggling to keep up with ballooning demand for GLP-1 weight loss drugs and in some cases are eliminating or restricting their coverage as a result."  MORE >>

"What are voluntary health benefits? ... How do premium payments for voluntary benefits work? What are the costs to employers and employees? ... How can plan members sign up to participate in voluntary benefits? Can individual employees and/or dependents pick and choose what they want to participate in? ... Is the implementation of voluntary benefits different for fully insured vs. self-funded plans? ... How widespread are voluntary benefits among employers today?"  MORE >>

"As of 2024, Gen Z [those born between 1997 and 2012] ... officially outnumbers baby boomers in the workforce, with millennials being the largest generational cohort.... This shift has elevated demand for benefits tied to wellness, flexibility, and financial security. Employees increasingly want emergency savings programs, student loan repayment assistance, and mental health benefits -- all of which are now climbing the ranks of must-have offerings."  MORE >>

"The Patients Deserve Price Tags Act [S 2355] ... aims to increase transparency around healthcare prices by establishing new requirements for virtually all healthcare stakeholders and creating stronger mandates for federal agencies to enforce compliance."  MORE >>

Published Sep. 4, 2025.  Changes to benefits-related items from the Fall 2024 DOL Regulatory Agenda:

Added to Proposed Rule Stage:

• Improving Transparency into Pharmacy Benefit Manager Fee Disclosure [1210-AB37]
• Transparency in Coverage [1210-AC30]
• Default Electronic Disclosures by Employee Welfare Benefit Plans Under ERISA [1210-AC35]
• Employee or Independent Contractor Classification Under the Fair Labor Standards Act [1235-AA46]

Moved from Final Rule Stage to Proposed Rule Stage:

• Performance Benchmarks for Multi-Asset Class Investments [1210-AC26]

Added to Final Rule Stage:

• Removal of Interpretive Bulletins Relating to [ERISA] of 1974 [1210-AC32]
• Selection of Annuity Providers -- Safe Harbor for Individual Account Plans [1210-AC33]
• Removal of 2550.401c-1, Definition of 'plan assets'-insurance company general accounts [1210-AC34]
• Investment Advice Fiduciary Under ERISA [1210-AC36]
• Prudence and Loyalty in Selecting Plan Investments and Exercising Shareholder Rights [1210-AC37]

   MORE >>

Published Sep. 4, 2025.  Changes from the Fall 2024 IRS Regulatory Agenda:

Added to Proposed Rule stage:

• Indian Tribal Governmental Plans [1545-BI19]
• Minimum Vesting Standards [1545-BN49]
• Electronic Furnishing of Payee Statements Regarding Digital Asset Sales by Brokers [1545-BR47]
• Modification to Section 415(c) Compensation Definition Relating to Back Pay [1545-BR49]
• Determination of Target Normal Cost and Funding Target for Single-Employer Defined Benefit Pension Plans [1545-BR50]
• Transparency in Coverage (CMS-9882) [1545-BR51]

Moved from Proposed Rule stage to Final Rule stage:

• Regulations Governing Practice Before the Internal Revenue Service [1545-BQ12]
• Automatic Enrollment Requirements under Section 414A [1545-BR08]
• SECURE 2.0 Act Updates to Catch-up Contribution Rules Under Section 414(v) [1545-BR11]

MORE >>

"Milliman this week reported that a healthy 65-year-old couple enrolled in Medicare and with supplemental Medigap Plan G Plus Part D coverage will need to save an average of $388,000 for healthcare costs -- a $7,000 decrease compared to last year's estimate of $395,000. This includes prescription drug coverage, hearing, vision, and dental benefits, and out-of-pocket costs."  MORE >>