"[F]or medical leave benefits a state pays to an individual in calendar year 2026, with respect to the portion of the medical leave benefits attributable to employer contributions, a state or an employer: [1] is not required to follow the income tax withholding and reporting requirements applicable to third-party sick pay; [2] is not required to comply with related information reporting requirements; [3] is not required to withhold and pay associated taxes; and [4] will not be liable for any associated penalties."  MORE >>

"[Notice 2026-05] links to two websites containing qualifying telehealth services lists ... Employers may need to work with their telehealth provider to determine whether their services are 'consistent with the principles of' Social Security Act section 1834(m).... It is theoretically possible for an employer to structure an onsite clinic offering [direct primary care service arrangements (DPCSA)] membership with items and services provided outside the DPCSA, available to employees who are not DPCSA members, and billed separately.... If a DPCSA arrangement does not meet the Notice requirements, it provides medical care and would be considered disqualifying insurance preventing HSA eligibility."  MORE >>

"CMS has proposed two mandatory Medicare drug pricing models: the GLOBE Model (for Part B drugs) and the GUARD Model (for Part D drugs). Both models would link Medicare drug rebate calculations to international pricing benchmarks from 'economically comparable' countries. If finalized, the GLOBE and GUARD Models would create new and potentially significant rebate obligations for drug manufacturers."  MORE >>

"The Trump administration has introduced three most-favored-nation (MFN) drug pricing initiatives designed to link U.S. pharmaceutical costs to prices paid in economically comparable countries. Most-favored-nation pricing requires manufacturers to provide rebates when U.S. prices exceed those in reference nations—a direct response to the persistent gap between U.S. drug prices and those in other developed economies. [This article summaries three programs that] have been implemented: [1] GENEROUS (GENErating cost Reductions fOr U.S. Medicaid) Model; [2] GLOBE (Global Benchmark for Efficient Drug Pricing) Model; [3] GUARD (Guarding U.S. Medicare Against Rising Drug Costs) Model."  MORE >>

"The DOL guidance is fairly clear. But have the courts agreed? Very few courts have given us guidance as to whether travel time itself qualifies as part of the FMLA leave allotment, but those that have, generally side with the DOL."  MORE >>

"[T]he DOL made clear that the covered leave is limited to travel related to the medical appointment.... For purposes of covering travel time, the DOL indicated that a medical certification is sufficient if it does not include information regarding travel time necessary for a patient to get to and from a needed appointment, as the health care provider's knowledge does not extend that far."  MORE >>

"Ways and Means Committee Chairman Jason Smith (MO-08) and Energy and Commerce Committee Chairman Brett Guthrie (KY-02) announced the details for an upcoming hearing with five of the biggest health insurance company CEOs to answer questions on making health care more affordable for all Americans.... The date of the hearing will be January 22, 2025 ... Company CEOs in attendance will be UnitedHealth Group, CVS Health, Elevance Health, The Cigna Group, and Ascendiun (the parent company of Blue Shield of California)."  MORE >>

"Given the rapidly evolving GLP-1 landscape, it may be prudent for plan sponsors to: [1] Evaluate the use of prior authorization, step therapy, quantity limits, or outcome-based wellness designs to manage utilization and cost exposure.... [2] Analyze HIPAA nondiscrimination risks by limiting mid-year changes to coverage and confirming that similarly situated plan participants, regardless of disability status, are subject to the same GLP-1 coverage terms. [3] Ensure all utilization management techniques are analyzed in the plan's comparative analysis ... to ensure parity in the plan as written and in operation."  MORE >>

"Both [OMB] and the Spring DOL Regulatory Agenda have teased an upcoming requirement for [PBMs] to disclose fees and rebates to ERISA health plan fiduciaries.... The 2025 new trend extending into 2026 is making prescription drugs available directly to consumers at lower costs,.... New electronic disclosure rules for health plans ... This year should bring additional transparency rules."  MORE >>

"A benefits broker request for proposal (RFP) can unlock crucial information about the employee benefits marketplace, your own total rewards offering, and the level of support your HR team could receive.... A well-run benefits broker RFP helps organizations evaluate brokers objectively, compare service models, and select a long-term partner that aligns with business goals and employee needs."  MORE >>

16 pages. "[T]his research demonstrates that ensemble-based deep learning methods -- especially autoencoder ensembles -- offer a robust, scalable, and adaptable solution for anomaly detection in the insurance industry. The pilot project confirms their potential to enhance fraud detection processes, reduce manual workload, and improve decision-making, while opening avenues for further innovation in data-driven risk management."  MORE >>

"A critical but less mentioned driver of recent premium increases is the post-COVID surge in prices paid by commercial insurers to hospitals. Limited availability and substantial lags in hospital price data have impeded timely analysis of these trends.... [D]ata from the California Department of Health Care Access and Information (HCAI) ... clearly demonstrate a post-COVID hospital price increase in that state, raising questions about whether this will be a temporary shock or a 'new normal' for the health care system going forward."  MORE >>

"This article provides a listing of 2026 statutory limits for pension and health and welfare plans in the United States.... These limits potentially impact design, administration, communication and tax reporting for the related benefit plans."  MORE >>

"Employers that are considering whether to fund these Accounts may find that there are more effective ways of providing compensation and promoting savings. Employees may be more interested in placing money into a more flexible savings option, such as a retirement savings account, Health Savings Account or 529 account."  MORE >>

"Employers have no legal obligation to contribute to Trump Accounts, but tax-exempt employer contributions may enhance employee benefit offerings.... [R]ecent IRS guidance confirms the following: [1] Employers may contribute up to $2,500 to employees' or their children's Trump Accounts pre-tax.... [2] The $2,500 limit applies on a per employee basis ... [3] Any employer contributions must be made pursuant to a written plan document and the contributions must comply with applicable nondiscrimination testing rules[.]"  MORE >>