"Paid interns who average at least 30 hours per week are full-time employees under the ACA. Excluding them from group health plan coverage could trigger employer shared responsibility penalties ... Full-time paid interns may be excluded from coverage without penalty exposure if they qualify as seasonal employees under a properly structured measurement period. The key word is 'properly.' "  MORE >>

"Health systems, hospitals, physician practices, electronic health record (EHR) vendors, and digital health developers are now joining payers as a unified coalition aligned around a single mission: making electronic prior authorization work end-to-end, on time, for every patient. Committed working groups across these stakeholders will align on CMS Interoperability and Prior Authorization Final Rule deadlines, addressing workflow gaps and technical handoffs that no single sector can fix alone. Prior authorization touches every part of the health care system; now, every part has a seat at the table."  MORE >>

"The Tennessee General Assembly recently passed the Freedom, Access and Integrity in Registered Pharmacy Act, known as the FAIR Rx Act (SB 2040/HB 1959). The legislation targets vertical integration in the pharmacy market by prohibiting certain entities from owning or controlling a pharmacy while also owning or controlling a PBM and a health insurance issuer. This is not a minor transparency bill. It is not simply another reporting requirement. It is a structural reform bill."  MORE >>

"The court next addressed the insurer's structural conflict of interest because it served as both the LTD plan's administrator and insurer. It noted that abuse of discretion review is 'tempered by skepticism' and that conflict is to be considered. However, the court gave this conflict little weight because the insurer's determination was supported by the results of a thorough, neutral and independent review process." [Wallace v. Hartford Life Ins. Co., No. 25-2716 (9th Cir. Apr. 17, 2026)]  MORE >>

"A Wisconsin federal court denied summary judgment to the employer on both FMLA interference and retaliation claims brought by a production employee terminated after his company switched FMLA administration to a third-party administrator whose phone system was, in the employee's words, 'almost impossible to get ahold of anybody.' The court found a reasonable jury could conclude the TPA's broken system discouraged the employee from taking FMLA leave, and that the employer's stated reasons for firing him were causally connected to his FMLA use." [Severson v. S.C. Johnson and Son, Inc., No. 24-1063 (E.D. Wisc. Apr. 27, 2026)]  MORE >>

"Employers often seek to address situations where the waiting period places the company at a competitive disadvantage in recruiting new employees.... In many cases, a practical solution to address this waiting period issue is for the employer to reimburse all or a portion of the employee's COBRA premium for coverage through a prior employer.... Reimbursing the COBRA premium helps offset that expense and facilitate the temporary coverage bridge before enrollment in the new employer's plan."  MORE >>

"To stabilize benefits budgets and prepare for the future, employers can focus on three structural priorities to redefine and manage healthcare costs. [1] Start renewal planning early ... [2] Leverage predictive analytics to negotiate better pricing and forecast risks ... [3] Use data warehouses to help integrate and analyze claims."  MORE >>

"Under the settlement, the Plan agreed to pay $245,000 to OCR and to implement a two-year corrective action plan. While OCR routinely enters into settlement agreements with regulated entities, actions directly targeting employer-sponsored group health plans remain relatively rare, making this case noteworthy for plan sponsors."  MORE >>

"Only about 24% of manufacturing employers report having a comprehensive wellbeing strategy that focuses on the 'whole employee'. In healthcare, that figure rises to just 29% -- a sign of growing recognition of stress and burnout, but also of ongoing capacity constraints. Among financial institutions, 39% of organizations report a comprehensive whole‑employee wellbeing strategy ... Without industry‑specific benchmarking, an employer could easily misread whether its wellbeing offer is table stakes or truly differentiating for its sector."  MORE >>

"Enrollment may be over, but your communication shouldn’t stop. Here’s how to talk to your employees year-round to help them appreciate their benefits and make smart decisions."  MORE >>

"While the Morgan Stanley dispute is still pending in the Southern District of New York, recent developments in the Fourth Circuit have indirectly affirmed the conclusion of the [DOL Advisory Opinion 2025-03A] by establishing certain factors that the court used to determine ERISA versus non-ERISA status with respect to compensatory arrangements.... The Fourth Circuit established a non-exhaustive list of six factors to be considered when determining whether an incentive compensation program is an ERISA-exempt bonus plan." [Milligan v. Merrill Lynch, Pierce, Fenner & Smith, Inc., No. 25-1385 (4th Cir. Apr 14, 2025)]  MORE >>