"To prepare for open enrollment, employers that sponsor health plans should be aware of compliance changes affecting the design and administration of their plans for plan years beginning on or after Jan. 1, 2026. These changes include limits adjusted for inflation each year, such as the Affordable Care Act’s (ACA) affordability percentage and cost-sharing limits for high-deductible health plans (HDHPs). Employers should review their health plans’ design to confirm that they have been updated, as necessary, for these changes."  MORE >>

"[FAQs Part 72] declared that certain types of fertility benefits will be 'excepted benefits,' exempt from various requirements of [HIPAA], such as health status nondiscrimination. In addition, various [ACA] requirements, like the prohibition on annual and lifetime dollar limits for essential health benefits and the requirement for preventive care coverage, will not apply provided certain conditions are met, and thus make fertility benefits easier for employers to provide."  MORE >>

"As employers, brokers, and advisors work through their fourth quarter compliance checklists, we cannot forget to include submission of GCPCAs as a necessary 'to-do.' It should surprise no one that this year, there are important changes to take notice of before the submission process begins."  MORE >>

"Since 2020, eight states plus the District of Columbia have launched new, mandatory statutory disability and paid family medical leave (PFML) programs, with Minnesota and Maryland scheduled to follow in 2026 and 2027. Meanwhile, California, Hawaii, New Jersey, New York, Puerto Rico, and Rhode Island continue to operate long-standing programs. This rapid expansion, coupled with the rise of remote work, creates new compliance challenges for employers."  MORE >>

"PFL wage replacement benefits claims filed on or after July 1, 2028 will be available for employees who take time off work to care for a 'designated person' with a serious illness ... Employees will have to identify their 'designated person' at the time they request benefits and attest under penalty of perjury to either: [1] how the individual is related by blood to the designated person; or [2] how the individual's association with the designated person is the equivalent of a family relationship."  MORE >>

"Starting January 1, 2026, Minnesota will provide job-protected paid family and medical leave (PFML) for employees’ own health needs and to care for others.... Employers must submit the first premium payment by April 30, 2026, through Minnesota’s Unemployment Insurance (“UI”) system, covering wages paid from January 1 to March 31."  MORE >>

"The case ... underscores the broad discretion ERISA plan administrators hold in interpreting plan terms and determining beneficiaries.... Plan terms ... control the distribution of ERISA benefits. Even a common-law marriage finding under state law does not override a plan's definition of 'Domestic Partner.' " [Metropolitan Life Ins. Co. v. Wallace, No. 24-1520 (N.D. Tex. Oct. 22, 2025)]  MORE >>

"Although TPAs largely operate behind the scenes, their practices directly influence employers' costs and employees' access to health care. This explainer examines what TPAs do, how they differ from traditional insurers, the regulatory environment in which they operate, and related policy concerns and issues."  MORE >>

"[1] Fiduciary litigation against health plan sponsors ... [2] The back-and-forth around mental health parity rules ... [3] Changes under the One Big Beautiful Bill Act."  MORE >>

"Voting leave requirements vary widely -- some mandate paid time off, others unpaid, and several include posting or notice obligations.... State laws change frequently -- conduct a yearly compliance review ahead of each election cycle.... Voting leave laws generally depend on the employee's work location, not the company's headquarters."  MORE >>

"Similar to 2025, on average, tax credits are projected to cover 91% of the lowest cost plan premium in 2026 for eligible enrollees. This compares to 85% in the 2020 coverage year, which was the last coverage year not impacted by temporary COVID-19 pandemic policies. The average Marketplace premium after tax credits is projected to be $50 per month for the lowest cost plan in 2026 for eligible enrollees."  MORE >>

"[A recent GAO report's] recommendations were structured around five pre-identified areas of potential reform: strengthening primary care; expanding the health care workforce; reforming pricing to better align with high value care; revising Medicare physician payments; and mitigating anticompetitive actions and practices.... [The authors] the areas []they] believe are most critical for policymakers to consider and offer new insights that have gained salience given shifts in the policy landscape since the forum was conducted."  MORE >>

"Hospitals can do math. Combating a clear, prompt, and defensible payment requires staff time, letters, appeals, and sometimes legal counsel.... If your plan pays a transparent multiple of Medicare, if your language is precise, if your appeals correspondence is professional, and if your member advocacy is proactive, the hospital's marginal ROI on fighting you is poor. They often accept ... because you act like a payer with a system, and the effort isn't worth the benefit."  MORE >>

"Coverage itself, because it’s basically at heart a contract based inquiry, is reasonably consistent – to at least some extent – from one jurisdiction to the next. But bad faith, when an insurer has to settle and what are the penalties for failing to settle when it was required, vary greatly from one state to the next. ... [H]ere are the key highlights of the duty of an insurer to settle claims in Massachusetts, and the liabilities that can run with breaching it."  MORE >>