"[This] additional guidance clarifies that CMS will offer this September 30-October 1 data change window to allow issuers to submit revised rates and forms approved by the state, CMS Rate Review, and/or CMS Form Review, as applicable, regardless of the outcome of any pending motions or litigation, and that the window will be open to all health insurance issuers applying for Plan Year 2026 QHP Certification on the FFE."  MORE >>

"Covered entities, including group health plans, must continue to comply with the HIPAA privacy and security requirements that were in place before the 2024 final rule took effect. However, any updates to policies and procedures that specifically address the final rule on reproductive healthcare should not be followed, particularly in response to law enforcement activity."  MORE >>

"The Office for Civil Rights (OCR) at [HHS] released updated FAQ guidance on individuals' rights to access their protected health information (PHI) from their healthcare providers and health plans. An additional FAQ was issued on the disclosure of PHI to value-based care arrangements, such as accountable care organizations, without the individual's authorization."  MORE >>

"[U]nder a DOL regulatory safe harbor, group insurance arrangements that meet specified requirements are exempt from ERISA.... Many supplemental insurance arrangements offered at the workplace will constitute voluntary employee-pay-all arrangements that fall within the safe harbor -- so long as employer involvement is sufficiently limited. An arrangement that does not satisfy the voluntary plan safe harbor likely will be subject to ERISA and its many compliance obligations[.]"  MORE >>

"Consider the possibility of ERISA preemption.... Confirm whether self-funded plans are in scope (and reach out to state regulators if needed).... Comply in a modified manner with an accompanying assertion.... Customize compliance state-by-state.... Clarify when compliance liability rests with the PBM.... Consider HIPAA exposure."  MORE >>

"A full 27 percent of respondents reported that they or someone on their health plan had a mental health condition. These respondents were more likely to be between 25 and 54 years old, more often married with children, and more often employed at smaller firms.... Respondents reporting a mental health condition were twice as likely as those not reporting a mental health condition to be unable to get medical care, tests, or treatment they or a doctor believed necessary over the past six months."  MORE >>

"Employer-sponsored health insurance (ESI) is the primary source of health coverage for working non-elderly adults, but adults working part time (fewer than 35 hours per week) have less access to these benefits than their full-time counterparts. Among non-elderly adults employed by public or private employers (excluding the self-employed), 18.5 million, or 14% of adult workers, work part time. This report examines the characteristics of part-time workers and their access to employer-sponsored health benefits."  MORE >>

"[L]eave programs are constantly expanding and evolving with new legislation at the state and/or local level.... When designing employee leave policies, employers may think a single, extensive general policy will cover all situations. However, leave management is a multi-layered process that requires well-defined, specific guidelines."  MORE >>

"The newly confirmed Assistant Secretary of Labor and head of the Employee Benefits Security Administration has pledged to streamline retirement plan oversight and end the ‘war on ESOPs.’... During his confirmation hearing, he stressed that he intends to make clear that fiduciaries, not the DOL or plaintiffs’ lawyers, should decide what is best for retirement plan participants."  MORE >>

"The decision reaffirms that: [1] Reconsideration is an extraordinary remedy, not a vehicle to reargue issues already decided. [2] District courts maintain discretion to allow discovery in ERISA cases, particularly where issues of bias or fairness may be explored. [3] Insurers opposing discovery must identify specific burdens or improper requests; generalized objections are inadequate." [Gaines v. United of Omaha Life Ins. Co., No. 25-0167 (N.D. Ind. Sept. 18, 2025)]  MORE >>