"Instructions for Recipient: This Form 1095-B provides information about the individuals in your tax family (yourself, spouse, and dependents) who had certain health coverage (referred to as 'minimum essential coverage') for some or all months during the year. " [Also available: 2025 IRS Form 1094-B: Transmittal of Health Coverage Information Returns]  MORE >>

"The adjustment for 2026 represents a $100 increase to the $3,300 health FSA salary reduction contribution limit for 2025.... The indexed carryover limit for plan years starting in calendar year 2026 to a new plan year starting in calendar year 2027 increases to $680. The carryover amount does not count toward the annual contribution limit."  MORE >>

"The latest ESSTA amendments seek to mandate the front-loading of an additional 32 hours of unpaid safe and sick leave for employees upon hire and each calendar year thereafter ... [T]he bill seeks to expand the list of eligible safe and sick time uses for leave under the ESSTA.... The collapsing of the [NYC Temporary Schedule Change Act (TSCA)] into the ESSTA provides some consistency for employers who have struggled to synthesize these competing statutory schemes."  MORE >>

"To meet the requirements, the parent or stepparent must live in the plan's service area, and they must meet the IRS' definition of qualifying relative. The new rules take effect January 1, 2026. It will not apply to plans issued in other states, self-funded plans, Medicare supplemental insurance, specified disease policies, and hospital or accident-only policies."  MORE >>

"This case highlights challenges to plan actions under the No Surprises Act beyond independent dispute resolution (IDR). Plans and administrators must keep accurate and complete provider network databases to avoid legal risks and reduce costs for participants seeking out-of-network care. They must also focus on transparency in reimbursement determination disclosures to avoid ERISA breach of fiduciary duty claims" [Orrison v. Mayo Clinic, No. 24-1124 (D. Minn. Sep. 19, 2025)]  MORE >>

"The National Community Pharmacists Association, Iowa Pharmacy Association, American Pharmacists Association and Independent Pharmacy Cooperative filed a friend-of-the-court brief ... arguing that the law is legal and urging the 8th Circuit Court of Appeals to allow it to stand. The groups, which represent independent community pharmacies, say that PBM actions targeted by Iowa's law are driving unaffiliated pharmacies out of business and harming patient access to drugs." [Iowa Assoc. of Bus. and Ind. v. Ommen, No. 25-0211 (S.D. Iowa Jul. 21, 2025; on appeal to 8th Cir. No. 25-2494)]  MORE >>

"[W]ith regards to the supplemental insurance claim, the court said that the employer's knowledge of the employee's condition ... created an affirmative duty to inform. None of the employer's communications with the employee and his spouse clearly communicated that a $400,000 supplemental policy was in force and also required conversion. [The court] ruled that if 'the written materials are inadequate, then the fiduciaries themselves must be held responsible for the failure to provide complete and correct material information.' " [Erban v. Tufts Medical Center, No. 22-11193 (D. Mass. Aug. 12, 2025)]  MORE >>

"[E]mployers are navigating unsettled law on whether federal nondiscrimination requirements permit exclusions for gender-affirming care. Plan participants may challenge restrictions under statutes such as ACA §1557 and Title VII. Courts are distinguishing between state laws that restrict available care and federal nondiscrimination mandates that still apply to employer plans."  MORE >>

"This chart collection examines the most recent available trends in employee spending on deductibles, copayments, and coinsurance from 2012 to 2023 using a sample of health benefit claims for individuals under 65 ... Total annual health spending by, and on behalf of, a family of four with employer coverage tops $29,000 in 2024."  MORE >>

10 pages. "[M]ental health coverage was nearly universal among large employers, with 97 percent of surveyed plans offering mental health services but only 67 percent covering substance use treatment ... [J]ust 22 percent of employers [are] tracking employee utilization data.... A majority of employers were tracking and measuring relevant employee satisfaction ... Fewer than one-half of employers collected or received information on industry-standard network adequacy performance measure[.]"  MORE >>

"Most employers offer coverage for mental health services, but where they fall short is in tracking whether those benefits are working, according to a new survey.... [T]here is a significant opportunity for employers to do more in tracking network adequacy ... 73% of those surveyed covered telehealth, and 62% covered counseling and therapy visits. But notably fewer offered coverage for ongoing chronic needs (33%) or for culturally competent care (26%)."  MORE >>