"This article will discuss the simplified alternative method for furnishing Forms 1095-C to employees, the purpose of the Forms 1094-C and 1095-C, the importance of timely and accurately filing them with the IRS, and what to do if your business receives a proposed Internal Revenue Code Section 4980H Employer Shared Responsibility Penalty (ESRP) notice."  MORE >>

"While these benefits, which have become quite popular, are not subject to cafeteria plan or ERISA rules, compliance difficulties exist. For starters, the federal monthly limits are adjusted every year. In addition, some state and local jurisdictions have imposed employer mandates, leveraging the tax advantages of commuter benefits; still other jurisdictions provide tax-related incentives. This GRIST summarizes major issues concerning qualified transportation plans under federal, state and certain local laws."  MORE >>

"The plans argued that since Rule 128 places a direct obligation on ERISA-governed plans in the form of reporting and dispensing fee requirements, ERISA preempts it. ... The court noted that the rule applies to all plans, not just plans that fall under ERISA.... One critic of the decision pointed out that Rule 128 expressly refers to self-funded plans and establishes reporting requirements similar to the PBM rule that the Supreme Court found to be preempted by ERISA in Gobeille[.]" [Central States, Southeast and Southwest Areas Health and Welfare Fund v. McClain, No. 25-3938 (N.D. Ill. Sep. 2, 2025)]  MORE >>

"The Ninth Circuit also rejected the TPA's argument that ERISA shielded it from liability for administering plan terms that were designed by an employer/plan sponsor. In the Ninth Circuit's view, a TPA could be liable under Section 1557 when it implemented plan terms drafted by a plan sponsor." [Pritchard v. Blue Cross Blue Shield of Illinois, No. 23-4331 (9th Cir. Nov. 17, 2025)]  MORE >>

"Starting from Jan. 1, the pharma giants will offer their obesity drugs Wegovy and Zepbound through Waltz Health, a digital health company focused on helping employers buy affordable medications. Under the offering, employers will procure the injectables by paying upfront, fixed prices without involving rebates and fees, which are usually paid to PBMs as part of traditional drug purchases."  MORE >>

"While DPC offers compelling advantages, it isn't universally available. HR leaders should evaluate three key fit factors: [1] Geography and access ... [2] Workforce health goals ... [3] Plan structure and funding."  MORE >>

"As healthcare costs continue to rise, employers face a pressing challenge: designing plans that do more than provide coverage. They must guide members toward better care at a lower cost. The most effective path forward is embedding provider performance data into the very core of plan design, making quality and value inseparable from every member decision."  MORE >>

"[A]ny congressional deal on ACA subsidies that might happen this year, or in time to ride on the government spending bill needed by the end of January, might carry [some] employer-backed policies nearly enacted in December 2024. These include bipartisan proposals to ensure greater transparency in the healthcare system, expand site-neutral payment reforms that align payment rates for services across sites where patients receive outpatient care and restrict anti-competitive contracting provisions that limit plan sponsors' flexibility to design high-value plans."  MORE >>

"Congress must put small employers at the center of any reform effort. That starts with ensuring they have access to flexible, affordable coverage options, including the ability to self-fund, and expanding and making permanent Association Health Plans so small businesses can band together to negotiate lower costs."  MORE >>

"Despite their foundational role in promoting evidence-based care, utilization review strategies, particularly utilization management and prior authorization, have become a focal point of controversy within the health care system.... Given the growing scrutiny of utilization management and the need for transparent, clinically defensible approaches, ... Elevance Health's model [provides] a framework other payers might adopt, but also as a means of fostering greater understanding and alignment across the broader health care ecosystem."  MORE >>

"[1] Catch-up 401(k) contributions for higher earners over 50 must be made to a Roth ... [2] 401(k), 403(b), and 457(b) plan contributions go up in 2026 ... [3] Traditional and Roth IRA limits for 2026 ... [4] Expanded savings for small businesses and the self-employed ... [5] Paper statement requirement ... [6] Health savings accounts (HSAs) ... 2025 year-end deadlines."  MORE >>