"[T]he timing of enactment in late 2024 meant that it was too late for many employers to implement the alternative reporting format in time for reporting of 2024 coverage in 2025.... [E]mployers ... may want to consider this option for the upcoming 1095-C reporting season in 2026 for 2025 coverage.... This change ... allows employees to access their Form 1095-C with an on-demand access model and eliminates the confusion of another notice for employees who do not need their Form 1095-C."  MORE >>

"[You] have an ongoing obligation to provide the notice to new employees, within 14 days of their start date.... Another entity (such as your insurer) may provide the Exchange Notice on your behalf.... [As] a practical matter, 14 days is a short timeframe for the employer to provide a new employee's information to another entity that then sends the notice."  MORE >>

"The WHD clarified that although additional required hours, such as mandatory overtime, should be included in an employer's calculation of yearly FMLA leave, optional additional hours, such as voluntary hours that an employee was not originally scheduled but chooses to work, should not be included. The bottom line is that an employer should calculate an employee's FMLA leave usage to an hourly equivalent 'in a manner that equitably reflects the employee's total normally scheduled hours.' "  MORE >>

"[DOL Opinion Letter FMLA2025-02A] clarified that employers should calculate FMLA leave hours based on an employee's actual, normally scheduled workweek -- which includes any mandatory overtime hours and excludes any additional voluntary hours. Although the opinion letter restates fairly established principles of FMLA entitlement calculation, it provides helpful guidance for employers when calculating FMLA hours for employees who work non-traditional work schedules."  MORE >>

"To replace QTL/NQTL regulations finalized in 2013, the Departments of the Treasury, Labor, and Health and Human Services proposed regulations in 2023 that solicited 9,503 comments. After review, the Departments issued final regulations on September 10, 2024. The 2024 rules shift the focus of the regulations from the process of applying NQTLs to the outcomes of that application. The key changes are addressed [in this article]."  MORE >>

"If the [employer] health plan is [qualified health coverage (QHC)], the employee and any covered family members may be in a position to opt out of or substantially reduce PIP medical coverage offered by the auto insurer. This could leave the health plan as the sole source of medical coverage for injuries related to a car accident. Health insurers and self-funded group health plan sponsors should be ready to provide documentation to Michigan drivers (and any family members) indicating whether the health plan is QHC and, if so, confirming their coverage under the health plan."  MORE >>

"Beginning on January 1, 2026, PBMs will not be able to include spread pricing terms in their contracts.... The new law provides that PBMs have a fiduciary duty to both self-insured employer plan, and health insurance carrier clients ... [T]he law provides a mechanism for a plan sponsor to obtain quarterly disclosures of rebates and fees received from drug manufacturers, fees and assessments charged to network pharmacies, and payments made to pharmacies, as well as de-identified utilization information for the plan."  MORE >>

"To anyone who has peered into the machine-readable files (MRFs) mandated by price transparency rules or simply been on the receiving end of multiple bills and inexplicable explanation-of-benefits statements, it's clear that the health care industry does not strive for the relatively efficient, consumer friendly approach to pricing and payments practices found, for example, in the airline and cell phone industries.... To tackle this complexity, price transparency policies should be closely followed by additional reforms."  MORE >>

"[P]lan administrators must determine whether a detained worker remains covered under certain company benefit plans -- and when such coverage ceases. [1] 401(k) Plans: Will employee contributions stop? ... Will detention impact vesting service? ... Will detention trigger a distribution event? ... [2] Will detention trigger a loss of health plan coverage? ... [3] Deferred compensation plan ... [4] Action item checklist."  MORE >>