1121 pages. "This final rule contains provisions to improve implementation of the [ACA], including payment parameters and provisions related to the HHS-operated risk adjustment and risk adjustment data validation (HHS-RADV) programs, as well as 2027 user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This final rule also includes [1] provisions related to civil money penalties (CMPs) for noncompliant issuers and other responsible entities; [2] standards governing agents, brokers, and web-brokers; [3] the expansion and codification of hardship exemption eligibility; [4] implementation of the State Exchange Improper Payment Measurement (SEIPM); [5] provider access standards and essential community provider standards for QHP certification; [6] QHP certification of non-network plans; [7] a prohibition on issuers from including routine non-pediatric dental services as an Essential Health Benefit (EHB); [8] requirements related to defrayal for the cost of any State-required benefits in addition to the EHB; [9] cost-sharing flexibilities for catastrophic and individual market bronze plans; [10] establishment of catastrophic plans with plan terms of up to 10 consecutive plan years; [11] QHP issuer quality improvement strategies (QISs); and [12] revisions affecting which enrollees are included in Federal Basic Health Program (BHP) payment calculations to States. This final rule also includes amendments to implement certain provisions of the Working Families Tax Cut (WFTC) legislation."  MORE >>

"The final rule ... reduces federal Exchange user fees to help lower premiums, establishes new safeguards to prevent improper enrollments, ensures subsidies go only to eligible individuals, increases consumer choice, affordability, access and protections, and expands state flexibility to manage Exchange operations. The rule strengthens program integrity, expands consumer protections, promotes plan innovation and consumer choice, and restores greater authority to states."  MORE >>

"In the new final rule, CMS ... will give insurers the option to discontinue the standardized plans or continue offering them, including potential changes to cost-sharing. In addition, the final NBPP rule will allow insurers to offer catastrophic coverage with terms of up to 10 consecutive plan years, and will expand the hardship exemption that allows people to choose these plans."  MORE >>

"The proposed rules would allow fertility benefits to be offered outside of the employer's non-exempt group health plan (i.e., major medical plan) just like a limited-scope dental or vision plan. The new category of limited excepted benefits is proposed to apply to plan years beginning on or after January 1, 2027, and will apply to 'fertility benefits' offered under a separate policy, certificate, or contract of insurance, or generally not otherwise an integral part of the employer's other group health plan(s)."  MORE >>

"[T]he proposed regulations provide the main requirements in order for the fertility benefit to be a limited excepted benefit are: [1] Substantially all of the benefits must be for diagnosis, mitigation or treatment of infertility or related reproductive health conditions; [2] Benefits are capped at a combined lifetime maximum of up to $120,000 for the participant and their beneficiaries, indexed for inflation for plan years starting after 2028; and [3] The employer must provide a notice that clearly describes the coverage and meets other specified requirements."  MORE >>

"A recent resolution agreement between [HHS] and an employer-sponsored group health plan resulted in a $245,000 payment and a comprehensive corrective action plan. This serves as a timely reminder that the Security Rule's requirements apply squarely to plan sponsors, not just healthcare providers.... [This article discusses] the key details of this enforcement action ... what the required risk analysis entails and ... what you should prioritize to stay ahead of the curve."  MORE >>

"If you are a plan sponsor or a broker placing a specialty drug carve-out, this case has changed what you can rely on. Plenty of vendors in the market sell what they call specialty carve-outs, alternative funding programs, or international sourcing programs. Some are well-run programs. Others source drugs from outside the U.S. FDA-approved supply chain.... The court found Gilead likely to succeed in proving that international sourcing of FDA-approved drugs through AFPs is unlawful and that the companies and individuals facilitating it can be liable." [Gilead Sciences, Inc. v. Meritain Health, Inc., No. 24-3566 (D. Md. Jun. 24, 2025; on appeal to 4th Ci. No. 25-1828)]  MORE >>

"The court found that the domestic partner's unsworn letter ... was an 'incredibly slim reed' on which to disregard the decedent's 2022 beneficiary designation, suggesting MetLife filed the interpleader primarily to protect itself rather than out of genuine uncertainty about a viable competing claim. The court also found that interpleader litigation of this type is a routine aspect of MetLife's business, as evidenced by a nearly identical action filed the day after this one, a discounted panel counsel arrangement with its law firm reflecting the frequency of such litigation, and the formulaic nature of the filings across both cases." [Metropolitan Life Ins. Co. v. Cooper, No. 25-1161 (M.D.N.C. May 14, 2026)]  MORE >>

"Many health plans already include in-network virtual providers without requiring additional employer contracts or fees. Virtual care can improve access to specialty services, reduce delays, and support employee engagement in care. Employees may not realize virtual providers are covered through their health insurance network. Employers can increase utilization through proactive communication and collaboration with health plans."  MORE >>

"At its core, [FAB 2026-01] portends agency leadership's intended shift away from broad or aggressive enforcement strategies toward a more disciplined and targeted approach.... EBSA emphasizes its continued commitment to protecting plan participants and beneficiaries, with a focus on where enforcement resources have the greatest impact."  MORE >>

"Make sure HR personnel and benefits administrators ... avoid steering employees toward Medicare in lieu of coverage under your employer-sponsored plan.... If you offer an HSA benefit, make sure that employee contributions stop once they are enrolled in Medicare, and look out for any contributions made during a period of retroactive Medicare coverage.... While mandatory retirement age policies should generally be avoided, experienced counsel can help you navigate other potential options, such as voluntary phased retirement programs, as well as succession planning for owners or C-suite executives approaching retirement."  MORE >>

"This checklist helps employers understand their obligations and opportunities when an employee notifies them of their new marriage. Questions often arise on possible election changes, beneficiary rights and organizational policies. This checklist captures common compliance issues and offers helpful suggestions to avoid complications down the road."  MORE >>