"The court ruled that Reliance's interpretation was unreasonable 'because it completely elides the distinction between receiving medical care for symptoms not inconsistent with a preexisting condition and receiving medical care for a preexisting condition itself.'... The court deemed this position 'unreasonable -- full stop.' ... In the end, the court viewed Reliance as attempting to rewrite its policy after the fact[.]" [Johnson v. Reliance Standard Life Ins. Co., No. 23-13443 (11th Cir. Nov. 21, 2025)]  MORE >>

"Although ERISA cases are often reviewed based solely on what the claims administrator considered, the court emphasized that limited discovery is appropriate where the standard of review is arbitrary and capricious -- a standard that applies when the plan grants the administrator discretionary authority." [Miller v. American United Life Ins. Co., No. 25-1670 (M.D. Fla. Nov. 24, 2025)]  MORE >>

"[The employee] claimed that the inadequate notice caused her to lose health and dental insurance, resulting in medical bills and canceled dental procedures. The court dismissed the case, holding that even if the employee suffered the alleged injuries, she had produced no evidence that the injuries were traceable to the deficient COBRA notice." [Marrow v. E.R. Carpenter Company, Inc., No. 23-2959 (M.D. Fla. Feb. 4, 2025)]   MORE >>

"The class-action plaintiffs contend Meijer's smoking cessation wellness program did not satisfy ERISA Section 702 ... because participants who completed the program mid-year received only prospective relief rather than the 'same, full reward' of retroactive reimbursements for the entire plan year.... The complaint further alleges that the plan's 'Benefit Guides,' relied on by participants during enrollment, failed to include clear instructions to access the cessation program." [Trout v. Meijer, Inc., No. 25-1378 (W.D. Mich. complaint filed Nov. 5, 2025)]  MORE >>

"the Appeals Court ruled that the employee offered enough evidence to create a genuine dispute of material fact as to whether his wife needed care, a qualifying reason for leave under the FMLA, and whether the employer had sufficient notice. 'Requiring ironclad proof is more than summary judgment requires, and in a situation like this one, it would allow an employer to benefit from its failure to comply with the FMLA.' " [James v. FedEx Freight, Inc., No. 24-12907 (11th Cir. Nov. 7, 2025)]  MORE >>

"[E]mployees do not need to use 'magic words' or explicitly mention the FMLA to invoke these protections. [A] recent Eleventh Circuit decision ... illustrates this principle: notifying managers of a spouse's high-risk pregnancy and need for care may be enough to trigger an employer's FMLA obligations." [James v. FedEx Freight, Inc., No. 24-12907 (11th Cir. Nov. 7, 2025)]  MORE >>

"The court determined that ESI's claim that the Act applies only to consumer-oriented acts or practices is a requirement that does not appear in the statute, which was intended to govern the conduct of PBMs, pharmacies, and pharmacists. Additionally, the court found that ESI's interpretation of the statute would render the enforcement mechanism in the Act 'meaningless.' " [Lackie Drug Store, Inc. v. Express Scripts, Inc., No. 23-1669 (E.D. Mo. 2025)]  MORE >>

"Employers are weighing affordability against outcomes, exploring pharmacy levers, and considering wraparound programs to make GLP-1 coverage sustainable.... Start by reviewing your data, engaging your carrier or PBM, and educating employees on available resources. Aim for more than offering coverage. Build a long-term strategy that supports your people and your business."  MORE >>

"As the nation's largest employer-sponsored health insurance program, the FEHB Program covers more than 8.2 million federal government employees and retirees, and it was once celebrated as a national model for controlling costs while giving enrollees many health plan options. But next year, average enrollee premium payments in the system are set to jump more than 12%, on top of a 13.5% hike in 2025. The two-year increase is higher than what many private employers and their workers are experiencing."  MORE >>

"401(k), 403(b), 457(b) plans: Automatic Roth designation for catch-up eligible participants earning over $150,000 (as adjusted for inflation) ... Group health plans: gag clause attestation."  MORE >>

"Health, retirement and other employee benefit plan fiduciaries, sponsors and service providers should confirm and document that all plan fiduciaries, service providers and other plan workforce members are properly bonded to protect the plan against fraud and dishonesty, as well as avoid incurring liability for breaching the fiduciary responsibility requirements of [ERISA]."  MORE >>

"AI can improve benefits communication by translating and simplifying content ... AI can use a combination of plan data and member input to help members choose health plans ... AI can help benefit plans become more targeted in meeting a plan member's needs ... Plan sponsors can use AI to gain better oversight of their plans ... AI's ability to sift through large amounts of data quickly is an important tool for detecting fraud, waste and abuse ... AI without appropriate oversight becomes a liability factor[.]"  MORE >>

"This post highlights key employment and benefits considerations to address in preparation for a sale, offering practical insights to help sellers and company management navigate the sale with confidence and efficiency. Taking these preliminary steps and anticipating buyer diligence questions can help companies present a well-managed organization, streamline the diligence process, and accelerate deal execution."  MORE >>