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Health & Welfare Plans Newsletter

November 25, 2025

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[Guidance Overview]

New York City Employers Face New Safe and Sick Time Obligations: Will You Be Ready for the Compliance Deadline?

"The law ... will take effect in 120 days on Sunday, February 22, 2026... Employees must generally use their paid safe and sick time first before using time from this new unpaid bank.... Unlike the requirements for paid safe and sick time, employers are not required to carry over any unused time from this bank to the next year.... Employees may use safe and sick time for new reasons."  MORE >>

Tarter Krinsky and Drogin LLP

[Guidance Overview]

California Enacts New Rules for PBMs

"The new law [1] prohibits the practice of 'spread pricing,' in which a PBM charges the plan a price for prescription drugs that differs from the amount the PBM pays to the pharmacy filling the prescription.... [2] provides that PBMs have a fiduciary duty to both self-insured employer plan, and health insurance carrier clients ... [3] provides a mechanism for a plan sponsor to obtain quarterly disclosures of rebates and fees received from drug manufacturers, fees and assessments charged to network pharmacies, and payments made to pharmacies, as well as de-identified utilization information for the plan."  MORE >>

AssuredPartners

Eleventh Circuit Rejects Provider's Request to Vacate IDR Award Under NSA

"The Eleventh Circuit reasoned that the provider failed to meet the threshold for vacating an arbitration award under the Federal Arbitration Act (FAA) for fraud or undue means -- or because the arbitrator exceeded its authority." [Reach Air Med. Servs. LLC v. Kaiser Found. Health Plan Inc., No. 24-10135 (11th Cir. Nov. 19, 2025)]  MORE >>

Thomson Reuters Practical Law

Rhode Island District Court Dismisses ERISA Class Action Challenging Tobacco Surcharges

"This is the first decision granting a motion to dismiss in its entirety in an ERISA class action targeting companies that charge an additional insurance premium for participants who use tobacco products by claiming that the wellness programs violate ERISA's nondiscrimination test.... [T]he court found that ERISA and applicable regulations do not require retroactive reimbursement of tobacco surcharges paid earlier in the plan year before a participant completes the tobacco cessation program." [Williams v. Bally's Management Group, LLC, No. 25-00147 (D.R.I. Nov. 4, 2025)]  MORE >>

Holland & Knight

2025 U.S. Group Disability Market Survey

"The participating companies reported $19.9 billion in combined LTD, STD, and PFML in-force premium in 2024, an increase from $19.0 billion reported by the same companies in 2023.... The average LTD in-force PPL increased by 3.5% from 2023 to 2024, whereas the average STD in-force PPL increased by 3.1%."  MORE >>

Milliman

[Opinion]

Why Men's Health Should Be Defined as a Core Benefit

"Men represent half the workforce, yet remain one of the least engaged populations in preventive and routine care. From hormone imbalances to infertility, urinary concerns, sexual dysfunction and late-stage cancer diagnoses, men are silently struggling with issues that are largely treatable and manageable if caught early. This is not a knowledge gap. It's a system-design failure. And it's costing employees and employers alike."  MORE >>

Employee Benefit News [EBN]; login required

Benefits in General

[Official Guidance]

Draft of 2026 IRS Publication 15-A: Employer's Supplemental Tax Guide (PDF)

29 pages; Nov. 24, 2025. "What's New: [1] Social security and Medicare taxes for 2025.... [2] Moving expense reimbursements.... [3] Employer contributions to Trump accounts."  MORE >>

Internal Revenue Service [IRS]

District Court Confirms Only Named Plan Administrator May Face ยง 1132(c) Penalties

"The court reaffirmed the Tenth Circuit's strict interpretation of Section 1132(c), holding that only the designated plan administrator -- as named in the governing plan documents -- can be subject to penalties. Because the complaint identified Union Pacific officers as the plan administrators, and MetLife acted only as a claims administrator and alleged agent, the court dismissed the Section 1132(c) claim against MetLife." [Mayor v. Metro. Life Ins. Co., itself & as administrator of Union Pac. Corp. Nonagreement Life Ins. Plan 0149653, No. 25-0012 (D. Utah Nov. 21, 2025)]  MORE >>

Roberts Disability Law

Press Releases

2020-2024 Individual Payout Annuity Study: Data Request

Society of Actuaries

Webinars, Podcasts and Conferences
(Health & Welfare Plans)

Navigating the Future of Benefits Tech: AI, Engagement & Strategy

PODCAST

Brown & Brown

2025 Health Benefits Year in Review

December 10, 2025 WEBINAR

ECFC [Employers Council on Flexible Compensation]

Last Issue's Most Popular Items

PBMs Ask Eighth Circuit to Overturn District Court's Refusal to Halt FTC Proceeding

Duane Morris LLP

House Proposal Would Add HSA Restrictions

Ascensus

Eleventh Circuit Rejects Reliance Standard's Broad Interpretation of Preexisting Condition Exclusion

Roberts Disability Law

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BenefitsLink® Health & Welfare Plans Newsletter, ISSN no. 1536-9595.

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