68 pages. "What's New: [1] Changes to 'coverage month' definition for PTC/ APTC.... [2] Reporting entities no longer required to send minimum essential coverage (MEC) forms automatically."  MORE >>

"The Consolidated Appropriations Act (CAA) 2026 expands the compensation disclosure requirements under ERISA to require ERISA-covered group health plans to receive compensation disclosures from nearly all of their plan vendors ... The provision appears to be effective immediately and is likely applicable to contracts entered into or renewed between a plan and a service provider after the date of enactment (i.e., after February 3, 2026). Employers who are in the process of selecting a new service provider for their group health plan, including renewing, or extending the contract of an existing provider, should review the requirements and request the appropriate compensation disclosures from service providers."  MORE >>

"The current proposal only applies to self-funded group health plans but the DOL has requested comments on whether this applicability should be expanded.... The definition of covered service providers under the proposed regulation is designed to be expansive and cover many entities.... The required disclosures will provide plan fiduciaries with new insight into the revenue stream for covered service providers."  MORE >>

"Plan fiduciaries would be responsible for ensuring that they receive required disclosures. They would also be responsible for the reviewing the disclosures to determine whether any actions need to be taken in response to the disclosures, such as exercising their right to audit the accuracy of the disclosure."  MORE >>

"Disclosures are required in advance of the date the contract with the covered service provider is entered into, semi-annually, and upon request of the plan sponsor and are subject to audit rights by plan fiduciaries. If finalized, the regulations would become effective 60 days after they are issued, with an applicability date for plan years beginning on or after July 1, 2026 (i.e., January 1, 2027, for calendar year plans). Many of the provisions in the proposed regulation are similar to the provisions in the legislation passed by Congress earlier this year (Consolidated Appropriations Act (CAA), 2026) but differ in various respects. The final regulations will likely look to harmonize those varying provisions."  MORE >>

"Recently, the 2026 federal poverty level (FPL) was announced as $15,960 (up from $15,650 in 2025).... [E]mployers may use the federal poverty guidelines in effect six months before the start of the plan year when applying the FPL safe harbor."  MORE >>

"Under the amended ESSTA, beginning February 22, 2026, all employers, regardless of size, must also frontload 32 hours of unpaid safe/sick time to employees upon hire and at the start of each calendar year. Employees may use this unpaid leave immediately.... [E]mployers of any size must also provide employees with 20 hours of paid prenatal leave in a 52-week period. "  MORE >>

"Effective July 17, 2026, the coverage threshold will be reduced to 15 or more employees, regardless of where those employees are located.... The law also dramatically lowers the service and hours thresholds required for employee eligibility, making it easier for workers to qualify for family leave....The amended NJFLA gives employees who are eligible for both New Jersey earned sick leave and TDI or FLI the right to choose which type of leave benefit to use first."  MORE >>

This 186-page report describes, and organizes by topic in detail, over 200 FMLA decisions of federal and state courts from November 1, 2024 through October 31, 2025.  MORE >>

"Settlor decisions about premium-setting may offer a structural litigation defense. When premiums do not directly correlate to plan cost experience, plaintiffs have difficulty showing that alleged PBM overcharges increased their out-of-pocket costs.... If plan fiduciaries have determined that engagement or retention of a vertically-integrated PBM is prudent despite the potential conflicts of interest, plan sponsor/settlor decisions about plan design may help mitigate those conflicts." [Lewandowski v. Johnson & Johnson, No. 24-0671 (D.N.J. Nov. 26, 2025)]  MORE >>

"PBMs were established in the U.S. in the 1960s to help insurers and employers manage their prescription drug benefits. The Employee Retirement Security Act (ERISA) of 1974 further accelerated PBM growth by enabling large employers to utilize their services. Now, PBMs are massive conglomerates, often vertically integrated with health plans, insurers, group purchasing organizations, retail pharmacy chains, and so on. ERISA will be used once again – this time to introduce unprecedented transparency into the industry it helped create."  MORE >>

"Although it is lumped together with use, changes attributed to intensity may reflect shifts in service mix, coding practices, payment design, or the adoption of new technologies -- many of which operate through higher prices per episode rather than greater quantities of care.... Understanding whether spending growth is due to greater clinical need, expanded access, higher prices, or changes in how care is billed and paid requires closer attention to the institutional and market drivers of what is labeled as 'intensity.' "  MORE >>

"Plan administrators and service providers will need to take steps to avoid missing a statutory or regulatory deadline.... Alternatives to merely dropping off a filing at the post office would be obtaining a manual postmark, purchasing a certificate of mailing, or using certified or registered mail. These options may be impractical for bulk mailings, but they are options that may be considered in certain situations."  MORE >>

"When employees possess high benefits literacy, they can navigate plan options, enroll correctly, and make informed decisions that reduce financial stress. Benefits leaders can help by: [1] Moving beyond open enrollment for year-round educational opportunities. [2] Using AI tools for developing education materials and answering questions. [3] Personalizing benefits education to appeal to different age groups and life stages."  MORE >>