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Health & Welfare Plans Newsletter

September 18, 2025

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💼  2 New Job Opportunities

 

[Official Guidance]

Draft of Instructions for 2025 IRS Forms 1094-C and 1095-C: Employer-Provided Health Insurance Offer and Coverage (PDF)

21 pages. "Employers with 50 or more full-time employees (including full-time equivalent employees) in the previous year use Forms 1094-C and 1095-C to report the information required under sections 6055 and 6056 about offers of health coverage and enrollment in health coverage for their employees."  MORE >>

Internal Revenue Service [IRS]

[Guidance Overview]

COBRA Qualifying Event Notices from Employees and Dependents

"Employees or dependents are required to notify the plan within 60 days upon a loss of coverage caused by divorce or legal separation or loss of eligible dependent child status. They also have a 60-day notice requirement to notify the plan of a SSA disability determination (to extend to 29 months) or a second qualifying event (to extend to 36 months)."  MORE >>

Newfront

[Guidance Overview]

Dependent Care Assistance Programs: An Employer Guide

"At long last, the One Big Beautiful Bill Act (OBBBA) will increase the annual contribution limits for Dependent Care Assistance Programs (DCAP) ... Except for a one-year increase in the contribution limits during the COVID-19 pandemic, the contribution limits had not changed since 1986.... [1] Dependent Care Assistance Programs ... [2] Allowable expenses -- gainful employment ... [3] Allowable expenses -- care ... [4] Qualifying individuals ... [5] Annual contribution limits ".  MORE >>

HUB International

[Guidance Overview]

ACA Preventive Services Update and COVID-19 Vaccinations (PDF)

"For plans beginning on or after January 1, 2026, several updated recommendations are set go into effect, such as breast cancer screening for women for women aged 40 at average risk (Women's HRSA), Intimate Partner and Domestic Violence Screening at Counseling (USPSTF), and Osteoporosis to Prevent Fractures Screening (USPSTF). A new recommendation was published and is effective for plan years beginning on or after January 1, 2026, issued by the Women's HRSA, to provide patient navigation services for breast and cervical cancer screening and follow-up, as relevant[.]"  MORE >>

Gallagher

[Guidance Overview]

New Hampshire Employers Must Comply with New Unpaid Parental Leave Law in 2026

"Effective January 1, 2026, New Hampshire employers with at least 20 employees must provide unpaid leave rights for employees to attend medical appointments related to childbirth, postpartum care and infant pediatric care.... The law entitles covered employees up to 25 hours of unpaid leave from work to attend the employee's own medical appointments for childbirth or postpartum care, or the employee's child's pediatric medical appointments within the first year of the child's birth or adoption."  MORE >>

Duane Morris LLP

[Guidance Overview]

Refresher on MAPFML Requirements in Advance of Private Plan Updates

"Employers that meet the requirements of Massachusetts Paid Family and Medical Leave (MAPFML) law through a self-insured or third-party private plan administrator are required to renew their private plans for approval by the Massachusetts Department of Paid Family and Medical Leave ... on an annual basis, and the process begins during the quarter prior to the expiration of an employer's current exemption ... With this September 30 deadline approaching for some employers, [this article provides] a refresher on MAPFML requirements and note recent updates."  MORE >>

Mintz

Eleventh Circuit Upholds Health Plan Coverage Exclusions for Gender Affirming Care

"This recent Eleventh Circuit decision heralds a narrowing view of when health plan exclusions for gender-affirming care are deemed to be unlawfully discriminatory.... [At] least one district court addressing a similar health plan exclusion for gender affirming care for minors post-Skrmetti has reached a different conclusion from the Eleventh Circuit, albeit in the context of Section 1557 of the [ACA], not Title VII." [Lange v. Houston County, Georgia, No. 22-13626 (11th Cir. Sep. 9, 2025)]  MORE >>

Smith, Gambrell & Russell, LLP

Discovery in ERISA Benefit Claims: What Courts in the Ninth Circuit Allow

"Courts often require disclosure of how much insurers pay doctors and consultants.... Personnel reviews can show whether adjusters or consultants are rewarded for denials.... Statistical patterns can reveal systemic bias.... Insurers rely heavily on outside vendors to supply medical reviewers. Courts scrutinize those ties.... Courts allow probing where insurers repeatedly seek favorable opinions.... Insurers sometimes argue they've walled off claims from financial pressures. Courts want proof.... Courts typically reject overbroad or irrelevant requests."  MORE >>

Roberts Disability Law

Major Insurers Commit to Continued Vaccine Coverage

"AHIP said its plans will continue to cover all vaccines recommended by the ACIP as of Sept. 1, 2025, including updated formulations of the COVID-19 and influenza vaccines, with no cost-sharing for patients through the end of 2026. Members of AHIP include major insurance companies Aetna, Centene, Cigna, Elevance Health and Humana as well as major Blues plans and other health insurance plans like Oscar Health."  MORE >>

FierceHealthcare

Benefits in General

[Official Guidance]

IRS Disaster Relief Announcement WI-2025-04, for Taxpayers Impacted by Severe Storms, Straight-Line Winds, Flooding, and Mudslides in Wisconsin

"[I]ndividuals and businesses in parts of Wisconsin affected by severe storms, straight-line winds, flooding, and mudslides that began on August 9, 2025 ... now have until Feb. 2, 2026, to file various federal individual and business tax returns  ... [I]ndividuals and households residing or having a business in Milwaukee, Washington, and Waukesha counties qualify for tax relief."  MORE >>

Internal Revenue Service [IRS]

[Guidance Overview]

Military-Related Work Leave Hits Highest Rates Since 2006: Does Your Company Know How to Comply with USERRA?

"Employers must provide eligible employees with up to five years of unpaid leave during the life of their employment. Throughout this period, employers must maintain the employee's seniority, health care, and pension benefits.... USERRA applies to all employers -- private and public -- regardless of the number of workers."  MORE >>

Fisher Phillips

Why Professional Services Firms Are Investing in SOC 2 Audits

"A SOC 2 review evaluates the design and effectiveness of a firm’s controls related to security, availability, processing integrity, confidentiality and privacy. By undergoing this assessment, service firms can demonstrate transparency in their internal practices, reassuring clients and stakeholders that their sensitive data is being handled with the highest standards of care."  MORE >>

Withum Smith+Brown, PC

Employee Benefits Jobs

💼

Retirement Plan Consultant

Sentinel Group

Remote

View job as Retirement Plan Consultant for Sentinel Group

💼

VP, Sales Consultant (Retirement Industry)

FuturePlan, by Ascensus

Remote / CA

View job as VP, Sales Consultant (Retirement Industry) for FuturePlan, by Ascensus

Press Releases

Buckingham Welcomes Patrick J. Egan as Partner, Expanding Employee Benefits and Executive Compensation Services

Buckingham, Doolittle & Burroughs, LLC

New & Enhanced Benchmarking Solutions for Clients and Prospects

Fiduciary Decisions

Eric Stevenson to Retire as Leader of Nationwide Retirement Solutions; Kevin Jestice Tagged as Successor

Nationwide

Webinars, Podcasts and Conferences
(Health & Welfare Plans)

Preparing for Year-End and A Look Ahead for Plan Sponsors

September 30, 2025 WEBINAR

Groom Law Group

Claims and Appeals: Commonplace Issues Facing Plan Administrators

October 7, 2025 WEBINAR

Trucker Huss

Navigating What's Next: State Disability and Paid Family Medical Leave in 2026

November 19, 2025 WEBINAR

Lockton

Last Issue's Most Popular Items

New 2026 ACA Guidelines: Breast Cancer Screenings and Navigation Coverage

Grooms Benefit Solutions

AI in Employer-Sponsored Group Health Plans: Legal, Ethical, and Fiduciary Considerations

McDermott Will & Schulte

COVID-19 Vaccine Update: What Employers Should Know

Brown & Brown, Inc.

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

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