"The applicable dollar amount that must be used to calculate the fee imposed by sections 4375 and 4376 for policy years and plan years that end on or after October 1, 2025, and before October 1, 2026, is $3.84. The increase from the prior applicable dollar amount is calculated by multiplying $3.47 ... by the percentage increase of the projected per capita amount of National Health Expenditures published by HHS on June 24, 2025.... The percentage increase is calculated after adjustment to reflect updates to the data used to calculate the prior applicable dollar amount, $3.47[.]"  MORE >>

"While fertility vendors might start to offer policies, the usual carriers who offer worksite plans will more likely begin to offer a new policy. However, fertility policies may take some time to come to market, pending state insurance approvals.... Under the new guidance, employers can use these HRAs to provide fertility coverage that qualifies as an excepted benefit.... The new guidance clarifies that EAPs can cover fertility coaching and navigation services without any risk of losing their excepted benefit status."  MORE >>

"[A] table outlines the new or modified preventive care services that must be covered without cost-sharing beginning January 1, 2026, for calendar year plans."  MORE >>

94 pages. "[T]his GRIST summarizes the relevant year-end 2025 and 2026 compliance and policy developments expected to affect health and fringe benefit plans and leave programs and suggests action steps for employers. Topics covered include ... [1] Congressional outlook.... [2] Regulatory outlook.... [3] Litigation outlook.... [4] State outlook.... [5] Top 10 2026 health and leave benefit planning. "  MORE >>

"SB 41 goes beyond federal pricing transparency reforms by imposing an explicit fiduciary duty on PBMs to act in the best interests of their payer clients, which include both self-insured and fully insured ERISA health plans. The law also prohibits spread pricing, mandates pass-through rebates, requires state licensure, and introduces comprehensive disclosure obligations. Collectively, these provisions mark a fundamental shift in PBM accountability and create new compliance priorities for health plan sponsors, insurers, and other payers in California."  MORE >>

"Provisions that relate specifically to PBM business practices generally take effect on January 1, 2026, while those that will impact fully insured plans take effect on contracts issued, amended, or renewed on or after January 1, 2026.... [T]he law contains an express exemption to PBMs when providing services to self-insured multiemployer union (Taft Hartley) plans subject to ERISA."  MORE >>

"the Second Circuit noted that the employee contends that, because she signed the agreement only after being told by the employer's attorney that the release would not impact her ability to pursue her LTD claim, 'the evidence cannot support the conclusion that she knowingly waived her claims against the insurer.' " [Schuyler v. Sun Life Assurance Co. of Canada, No. 23-498 (2d Cir. Aug. 14, 2025)]  MORE >>

"Early detection is great, isn’t it? It will save money down the road, so shouldn’t we cover it? Before you decide to do so, consider these six points that the Validation Institute would argue go exactly the other way."  MORE >>

"AI is being used to streamline tasks such as verifying eligibility, adjudicating claims, and reconciling payroll. Service providers are deploying systems that can detect anomalies in claims data and tailor outreach based on participant demographics and financial needs.... Errors, such as misclassified procedures or misallocated funds, can occur, and accountability ultimately rests with the plan fiduciary, regardless of the technology involved.... Vendor relationships should be structured to allow for ongoing monitoring and documentation of AI-driven decisions."  MORE >>

"[1] My recordkeeper is the plan administrator.... [2] Nobody is complaining about our service providers or investments, so everything is fine ... [3] Our investment adviser is solely responsible for investment decisions.... [4] We must sign or approve whatever our recordkeeper sends us.... [5] Our fiduciary responsibilities apply only to our 401(k) and pension plans.... [6] We can do everything ourselves."  MORE >>