25 pages. "The AV Calculator [XLSM] represents an empirical estimate of the AV calculated in a manner that provides a close approximation to the actual average spending by a wide range of consumers in a standard population. This document is meant to detail the specific methodologies used in the AV calculation."  MORE >>

38 pages. "This 2027 Draft Letter provides updates on operational and technical guidance for the 2027 plan year for issuers seeking to offer qualified health plans (QHPs), including stand-alone dental plans (SADPs), in the Federally-facilitated Exchanges (FFEs) or the Federally-facilitated Small Business Health Options Programs (FF-SHOPs).... The 2027 Draft Letter focuses on guidance that has been updated for the 2027 plan year[.]"  MORE >>

"This article examines the CAA in the context of other federal and state efforts to regulate PBMs, then offers recommendations on additional steps Congress and federal agencies could take in this sphere."  MORE >>

"While initial discussions have focused on technical details, the proposal's greater significance lies in what it signals about evolving fiduciary expectations under ERISA and how plan sponsors can use this guidance to strengthen oversight.... Plan fiduciaries should view EBSA's proposal not only as a future compliance requirement, but also as a key indicator of how PBM oversight is currently evaluated."  MORE >>

"The Section 125 cafeteria plan rules provide that employees can make a mid-year health plan election change upon the change in residence of the employee, spouse, or dependent where a) the move affects the individual’s eligibility for coverage under the plan, and b) the health plan election change is consistent with the individual’s change in residence."  MORE >>

"Certain services performed in connection with a colonoscopy performed as a preventive screening procedure pursuant to the USPSTF recommendation must be covered without cost-sharing where the services are an integral part of the colonoscopy (subject to reasonable medical management).... Your plan must also cover, without cost-sharing, a follow-up colonoscopy conducted after a positive non- invasive stool-based test or direct visualization test."  MORE >>

"CMS proposes to prohibit issuers from including routing non-pediatric dental services as EHB.... This is a reversal of the policy finalized in the 2025 Payment Notice ... CMS had stated that, beginning in PY 2025, covered benefits in a State's EHB-benchmark plan are EHBs and, thus, do not require defrayal by the State. In this proposed rule, CMS notes that it has reevaluated this policy.... The proposal to certify non-network plans as QHPs is both a reversal and an expansion of previous policies."  MORE >>

"[T]he revised model notices can be a useful starting point, but plan sponsors should ensure that the final NPP language aligns with their actual practices and administration, and should coordinate updates with insurers, TPAs, and counsel. Given OCR's announcement of a civil enforcement program for confidentiality of SUD patient records, plan sponsors, group health plans, and business associates that receive and disclose information related to SUDs should act quickly to understand their obligations."  MORE >>

"Employers providing paid family and medical leave to their employees may be able to claim a tax credit under Internal Revenue Code Section 45S. This In Focus provides an overview of the employer credit for paid family and medical leave, its legislative history, and possible fiscal effects of the credit." [IF11141 updated Feb. 25, 2026]  MORE >>

"The New York City Department of Consumer and Worker Protection (DCWP) issued updated FAQs and other guidance clarifying the additional protections and requirements. At the same time, Mayor Zohran Mamdani announced renewed enforcement efforts targeting employers that fail to comply with municipal worker protection laws, including the ESSTA. So far, more than 56,000 warning letters on violations reportedly have been sent to employers across the city."  MORE >>

"[S]everal questions that were initially unanswered have been addressed, including: [1] Whether part-time employees and/or mid-year hires must be provided the full 32 hours of unpaid sick leave at the beginning of the year.... [2] Whether employers can provide 32 hours of additional paid sick leave in lieu of providing unpaid sick leave.... [3] When employees can use protected time 'to provide care to [a] minor child or care recipient'.... [4] In what increments of time unpaid sick leave may be taken."  MORE >>

"The court rejected the TPA's request to dismiss the case, allowing several claims to proceed. The court concluded that the participant plausibly alleged deceptive conduct under state law, determining that delayed disclosure of the fee and its characterization as a processing fee rather than an administrative fee could mislead participants, especially when the fee amount exceeded statutory limits. " [Patterson v. Wex, No. 25-8557 (N.D. Calif. Feb. 10, 2026)]  MORE >>

"$67 million was recovered for No Surprises Act violations ... A life insurer was required to update their evidence of insurability standards because they were not compliant.... A medical plan claims administrator had processed thousands of out-of-network emergency claims incorrectly, affecting 10,800 participants and 2,400 providers. The claims administrator has now established a trust fund to issue payments to participants and providers, so far payments exceed $11 million."  MORE >>

"Plan sponsors should consider the following strategies to ensure timely mailings when using USPS: [1] Request a manual postmark:... [2] Mail early.... [3] Postage validation imprint (PVI).... [4] Proof of mailing."  MORE >>