"[K]ey considerations and action items plan sponsors should address prior to the end of this year or at least prioritize in early 2026: [1] Telehealth coverage -- to charge or not to charge ... [2] Dependent care contribution limits -- should you increase the limit? ... [3] Direct Primary Care Arrangements -- some arrangements can be paired with an HSA.... [4] Remember gag clause attestations.... [5] Revisit last year's ACA reporting 'present'.... [6] Update HIPAA Notice of Privacy Practices.... [7] Mental Health Parity & Addiction Equity Act (MHPAEA) NQTL compliance still required.... [8] Routine year-end housekeeping."  MORE >>

"The guidance that enrolling in a [Direct Primary Care Arrangement (DPCA)] will not cause individuals to lose HSA eligibility is helpful. However, questions remain regarding how DPCA offerings can be structured so that their services can be reimbursed from an HSA, and what services may be treated as primary care services. In addition, [Notice 2026-5] provides some flexibility with respect to individuals enrolling in bronze and catastrophic plans off-Exchange or through an ICHRA."  MORE >>

"[HHS has] published a proposed rule ... that would carve out account-based group health plans from the requirement to provide a Medicare Part D-creditable coverage notice to Part D-eligible individuals. This exclusion would be welcome relief for account-based plan service providers and plan sponsors who offer an individual coverage health reimbursement arrangement (ICHRA) or another type of account-based group health plan, such as a health care flexible spending account (FSA), health savings account (HSA), or traditional health reimbursement arrangement (HRA)."  MORE >>

"Enacted into law in July of this year, the OBBBA brought us several new consumer-directed provisions ... The courts, including the Supreme Court, had a busy year as well.... The [ACA] made an appearance in 2025, notably in a major court case.... This year also saw the introduction of an alternative furnishing option for Forms 1095.... A flurry of fiduciary lawsuits this year shone a spotlight on the fiduciary responsibilities employers have as sponsors of group health plans.... [PBMs] also made their way onto this year's compliance-oriented center stage."  MORE >>

"Many federal laws create mandates that may apply to your group health plan. Here are some to be aware of: [1] [ACA] ... [2] [MHPAEA] ... [3] Women's Health and Cancer Rights Act (WHCRA) ... [4] Newborns' and Mothers' Health Protection Act (NMHPA) ... [5] [FMLA].... [6] [USERRA] ... [7] Medicare Secondary Payer (MSP) ... [8] Medicare Prescription Drug, Improvement, and Modernization Act (MMA) ... [9] Federal laws prohibiting employment discrimination."  MORE >>

"The changes set to take effect on January 1, 2026 once again increase the employee benefit and contribution caps established by the PFL program.... PFL benefits are separate and distinct from those provided by the New York State Paid Sick Leave (PSL) law, under which accrued benefits vary on the basis of employer size. "  MORE >>

"Under the bill [HR 6703] ... lawmakers would lean on association health plans ... and individual coverage health reimbursement arrangements, or ICHRA, to offer additional options for enrollees....The bill also seeks to broaden access to stop-loss coverage to mid-size and small employers ... [Th]he legislation aims to address premiums by allocating for cost-sharing reduction payments beginning in 2027.... The bill also includes provisions to increase the transparency around pharmacy benefits[.]"  MORE >>

"[E]mployers favor utilization tactics over structural PBM reforms despite rising specialty drug spend.... Unsustainable specialty medication costs could erode benefits budgets and employee affordability.... 69% include pharmacy in medical plans; only 16% use pass-through PBMs."  MORE >>

"Doctors and groups representing employers said they're increasingly hearing about companies cutting weight loss drugs out of health plans next year as costs mount.... Some [employers] are starting to wonder whether they're paying more for obesity drugs than the cash prices being offered, which range from $200 to $450 a month depending on the dose ... That's leading companies to think it makes more sense for workers to get the drugs on their own[.]"  MORE >>

"While the increase sounds positive for employees, it can create challenges with nondiscrimination testing ... When the limit jumps to $7,500, HCEs are more likely to contribute the maximum, which can skew the ratio and increase the risk of failing the test. If you have had problems passing this test in the past, you will likely continue to have problems and potentially experience an even greater difference in the ratio."  MORE >>

"One approach is to offer the DCAP benefit only to non-HCEs.... Providing employer contributions to DCAPs can significantly boost participation among non-HCEs.... Reducing or eliminating minimum contribution requirements makes the plan more accessible to lower-paid employees who may have budget constraints.... Many employees who could benefit from a DCAP do not participate simply because they do not understand the program or its value."  MORE >>

"Health care spending data from five states show health care spending exceeded each state's target in 2023 ... Those five states are among nine that, since 2012, have established targets to contain rising health costs.... [T]he research reveals how health insurers that acquire physician groups and other provider organizations increase health care costs and avoid paying rebates to consumers under the medical loss ratio (MLR) rule in the [ACA]."  MORE >>

"[S]everal new laws will have significant implications for qualified retirement plans, including amendments that must be made by the 2026 plan year.... The recently enacted One Big Beautiful Bill Act (OBBBA) also contains provisions impacting health and welfare plans, many of which are effective beginning January 1, 2026.... [M]any cost-of-living adjustments that are mandated by law will impact retirement plans and health and welfare plans in 2026.... [This article provides] plan sponsors with summaries of the key action items they should be considering, now and in the future[.]"  MORE >>

"This guide provides a high-level reference resource, in a plan-by-plan format, on how to approach each benefit arrangement when an employee gets divorced, and offers up some practical tips on employee benefits issues that may arise as you manage your company's response to an employee's divorce."  MORE >>

"The forthcoming guidance would build on the DOL's 2020 electronic disclosure safe harbor, which allowed plan sponsors and recordkeepers to treat electronic delivery as the default for participants with valid email addresses or mobile phone numbers on file, subject to notice and opt-out requirements.... [T]he new SECURE 2.0 mandate underscores an enduring policy tension: how to capture the efficiency and engagement benefits of electronic communications without excluding participants who rely on, or prefer, paper."  MORE >>