"Specified-disease policies for infertility can be offered today if insured and noncoordinated. Excepted benefit HRAs can reimburse out-of-pocket fertility expenses within indexed limits. EAPs may include fertility navigation supports without becoming significant medical coverage. With potential rulemaking on the horizon, sponsors should align near-term offerings with current rules and be ready to evaluate new limited excepted benefit options as they emerge."  MORE >>

"It appears that this CAA transparency requirement, like others under the CAA, would not apply to retiree-only plans. For health reimbursement arrangements (HRAs) -- including individual coverage HRAs -- and other account-based plans, the Departments ... are using discretion when it comes to enforcing this requirement until they can exempt these plans through the official rulemaking process."  MORE >>

"For a covered service provider's compensation to be considered reasonable, the service provider must disclose specified information in advance and in writing to a responsible plan fiduciary. Broadly, the disclosure must describe the services to be provided, indicate whether the service provider expects to be a plan fiduciary, and describe all forms of direct and indirect compensation the service provider expects to receive in connection with the arrangement, including the manner in which compensation will be received."  MORE >>

13 pages. "By the end of the third quarter, most state legislatures were adjourned for 2025 ... Opponents of PBM laws in Arkansas and Iowa won early battles in court. Another Arkansas PBM law was upheld in court. California mandated coverage of abortion medication. Illinois and North Carolina saw expansive PBM laws.... Missouri repealed its paid sick and safe leave (PSSL) law, effective Aug. 28. Alaska issued final PSSL rules for its law, effective July 1. ... San Francisco and Seattle announced 2026 changes to their benefit-related ordinances."  MORE >>

"SB 41 regulates PBM business conducted in California with the goal of lowering prescription drug costs and increasing transparency. It bans spread pricing, requires pass-through pricing and rebate pass-through, curbs steering to affiliated pharmacies, imposes truth-in-dealing standards, restricts certain exclusivity deals with manufacturers, and establishes PBM licensure/oversight."  MORE >>

"PBMs must move to a 'passthrough pricing model' under which the amounts paid by a plan or insurer for a covered drug are passed through in full to the dispensing pharmacy, inclusive of any contracted professional dispensing fee, without reconciliation offsets. Spread pricing is barred in contracts executed, amended, or renewed on or after January 1, 2026; any preexisting spread-pricing authorizations cannot persist into future amendments or renewals, and such terms become void on and after January 1, 2029."  MORE >>

"Employees in California who are victims of violence -- and their family members who are victims -- now have expanded leave protections when they seek legal, medical, mental health, or safety planning services. The new law, Assembly Bill (AB) 406, which Governor Gavin Newsom signed on October 1, 2025, and which took effect immediately, prohibits discrimination and retaliation and clarifies employer obligations, documentation options, and confidentiality."  MORE >>

"Many employers reported that use was higher than expected and covering them significantly increased prescription drug cost.... In some cases, employers reported adding or strengthening case management programs or changing utilization management requirements. Several firms that initially covered GLP-1 drugs for weight loss have since restricted coverage to only cover GLP-1 agonists for employees with specific medical indications, like diabetes. These firms face the challenge of removing benefits from employees who may like and value the coverage."  MORE >>

"Employers may structure their open enrollments as either active or passive.... Employers ... need to clearly communicate when the open enrollment period starts and ends.... Employers should be conscious of those who newly become eligible for their plans around the time of open enrollment as there may be confusion around the timing of elections.... While the IRS determines the allowable limits under the tax code, employers determine the allowable contribution limits under their [account-based] plans."  MORE >>

"[1] Start early and keep it going ... [2] Sequence your messaging ... [3] Make sessions interactive ... [4] Set clear attendance expectations ... [5] Plan for year-round education."  MORE >>

"Overall, 18 percent was spent on inpatient services, 51 percent on outpatient services, and 31 percent on prescription drugs ... For enrollees with under $50,000 in spending, inpatient services represented only 9 percent of their total health care expenditure. This jumped to 58 percent for those with $2 million or more in spending.... [P}rescription drug spending as a proportion of total health care spending peaked in the middle-to-higher spending tiers (from $50,000 to $250,000) and then decreased for the very highest-spending enrollees."  MORE >>

"The growing volume of ineligible claims from out-of-network providers and private equity firms amounts to one of the most persistent abuses of the federal IDR process, according to researchers. Recent data ... estimates that the systemic flaws with arbitration and rampant misuse of the process have led to $5 billion in wasteful spending to date."  MORE >>

"The current U.S. health system is ill-equipped to respond to the 21st century needs of patients and communities. A health system overhaul is needed to put patients at the center of care, to prioritize health education and disease prevention, to provide care to patients where and when it is most convenient for them, and to leverage technology to do more with less. Reform also should seek to increase access and capacity and curb health care costs."  MORE >>