"Employers and plan sponsors should review their service agreements to ensure they do not contain gag clauses. They should also confirm if their medical insurance carrier, TPA, PBM or other service provider will complete a gag clause attestation on their self-insured plan's behalf. Employers and sponsors required to complete a Gag Clause Attestation for 2025 should be prepared to file their attestation no later than December 31, 2025."  MORE >>

"[An] employer's ACA penalty exposure hinges entirely on whether the organization satisfies the statutory definition of an 'applicable large employer' (ALE). This article centers on an organization's considerations as it grows into ALE status or shrinks out of ALE status."  MORE >>

"The direct-to-consumer (DTC) pharmacy space continues to evolve but is tightly regulated at the state level, with licensing and operational compliance as critical gatekeepers.... Third-party fulfillment models are more common but still require careful structuring and contractual controls to ensure compliance.... This alert outlines key considerations for entities pursuing DTC pharmacy strategies, including licensing, ownership structures and operational compliance."  MORE >>

"This new proposal -- open for public comment until November 17, 2025 -- withdraws the prior proposed regulations and reissues four chapters: General Provisions; Contributions; Equivalent Private Insurance Plans (EPIPs); and Dispute Resolution. The Claims chapter has not yet been reissued. Several key changes appear across the reissued chapters."  MORE >>

"New York City Earned Safe and Sick Time will be greatly expanded. Safe and Sick Time is separate from other types of requisite paid leave, including prenatal leave and preventative screening leave.... [E]mployers will also be required to provide additional unpaid leave to all employees, including new employees upon hire, with no probation period.... [U]nless vetoed by October 25, it will automatically become law -- taking effect 120 days after it was passed -- around January 23, 2026."  MORE >>

"[K]ey provisions ... include: [1] an 'any willing provider' requirement; [2] a prohibition on spread pricing; [3] a requirement to use a passthrough business model; and [4] a general prohibition on retroactive payment reductions and payment reductions through a reconciliation process. Effective dates vary, with many of the provisions applying to any contracts from January 1, 2019, or later and other provisions applying to contracts beginning January 1, 2026, or 2027."  MORE >>

"Plaintiffs continue to file lawsuits against employers challenging wellness programs that impose a health insurance premium surcharge on participants if they use tobacco and do not complete a tobacco cessation course -- in total, plaintiffs have filed more than 45 such lawsuits.... While some courts have dismissed the plaintiffs' claims in part, no court has dismissed a complaint in its entirety."  MORE >>

"[1] Prepare for record-setting renewals ... [2] Data is the most critical input ... [4] Vendor fatigue is real, and consolidation is coming ... [4] Communication is a year-round priority ... [5] Align benefits to business goals, not just renewal rates ... [6] Move from reactive to multi-year planning."  MORE >>

"Fewer than 1 in 5 people with ESI coverage had a midwife in their care team during their last pregnancy. However, those who did were engaged consumers ... Individuals who had a midwife as their sole maternity care provider were 30% less likely to have a c-section.... 66% of individuals are interested in midwifery care but may need supplemental education or baseline knowledge to help them solidify their decision."  MORE >>

"Most contracts with service providers (brokers, third-part administrators and pharmacy benefit managers) disclaim discretionary authority, limiting the service provider’s role to ministerial tasks spelled out in the agreement. In a fully insured plan, the carrier is always a fiduciary with respect to claims and appeals administration. That differs, however, from being the named fiduciary, which is almost always the plan sponsor or an individual employee, committee or board of the employer."  MORE >>

"Creating an effective healthcare strategy starts with data. Every employee population is unique, and our healthcare strategies should follow suit. By analyzing utilization trends, we can better understand the specific needs of our employees and opportunities for intervention to reduce the risk of high-cost medical events."  MORE >>

"Covering a little more than 750,000 lives, the [North Carolina State Health Plan (SHP)] spends between plan costs and employee contributions nearly $4.5 billion annually ... [The SHP] faces an estimated deficit of greater than $500 million for Calendar Year (CY) 2026 and a total projected deficit of $949 million by the end of CY2027. In this article, [the authors] review the challenges that drove the fiscal instability of the North Carolina SHP.... [They] then describe the dynamic, market-driven tools that we are applying to efficiently and effectively control costs with sensitivity to the varied needs of more than 750,000 SHP members."  MORE >>

"This report updates the maximum statutory valuation rate and nonforfeiture interest rate for calendar year 2026 issues of life insurance products and the maximum statutory valuation interest rates for calendar year 2025 issues of annuity products."  MORE >>

"The concurrence written by Circuit Judge Adalberto Jordan, joined by Circuit Judge William H. Pryor, Jr., is noteworthy. They propose to convene en banc to 'consider overruling Mason v. Continental Group ... which imposed a judicially created and atextual administrative exhaustion requirement for fiduciary breach and statutory claims under ERISA ... ' In the concurrence, Judge Jordan points out that the Eleventh Circuit is the only circuit with a mandatory exhaustion requirement and that the majority of circuits have held that 'plaintiffs asserting fiduciary-breach statutory claims under ERISA do not have to exhaust administrative remedies.' " [Bolton v. Inland Fresh Seafood Corp. of Am., Inc., No. 24-10084 (11th Cir. Oct. 15, 2025)]  MORE >>