"This time of year typically brings key filings such as Form 5500 for calendar-year plans, Patient-Centered Outcomes Research Institute (PCORI) fee payments, Summary Annual Report (SAR) distributions, and medical loss ratio (MLR) rebate considerations, among others. Staying ahead of these requirements is critical to avoiding potential penalties and maintaining compliance with applicable federal laws." [Includes both standard Federal deadlines, and select state and local deadlines.]  MORE >>

"[The final rules] affect how a group health plan communicates with out-of-network providers, participates in payment negotiations, and resolves billing disputes. Because self-insured group health plans are ultimately responsible for ensuring compliance with these new IDR requirements, plan sponsors should work with their third-party administrator (TPA) to confirm that existing processes meet the new standards. Where gaps exist, plan sponsors may want to revise the TPA services agreement to address the requirements summarized below and consider including indemnification provisions or performance guarantees to protect the plan in the event the TPA fails to comply."  MORE >>

"[T]he employer is only responsible for determining the following with respect to each employee: [1] whether the employee is covered under an HDHP or a non-HDHP (e.g., a general-purpose health FSA or HRA) sponsored by that employer; and [2] the employee's age, for determining whether the employee is eligible for age 55 catch-up contributions (the employer may rely on employees' representations as to their dates of birth)."  MORE >>

"Employees accrue one hour of paid sick leave for every 30 hours worked, beginning at the start of employment.... Employers may frontload the full 40 hours at the start of the year to satisfy the accrual requirement, in which case they are not required to allow carryover of unused leave into the following year.... For absences of three or more consecutive workdays, employers may require reasonable documentation that leave was used for a covered purpose."  MORE >>

"The updated rules, effective June 1, 2026, make a number of substantive additions and clarifications, including new guidance on joint employment, workplace posting, rate of pay for tipped employees, reasons for use, paid sick leave abuse, successor employer obligations, benefit year administration, universal PTO policies, and accrual for exempt & non-exempt employees."  MORE >>

"The PCMA is alleging that the PDAA will cause substantial harm to the association's members ... The PDAA was crafted to rein in the influential middlemen, which sit at the epicenter of the U.S. pharmaceutical supply chain and control the flow of drugs between pharmaceutical companies, insurers, pharmacies and patients.... [The Illinois law was enacted last July,] part of a larger wave of state legislatures across the country passing PBM reform legislation to the annoyance of market giants in the industry." [Pharmaceutical Care Mgmt. Ass'n v. Gillespie, No. 25-3200 (C.D. Ill. complaint filed Jun. 16, 2026)]  MORE >>

"In enforcement actions and audit findings, regulators have consistently identified deficiencies in comparative analyses, particularly where plans cannot adequately document how NQTLs are designed and administered. The most common MHPAEA compliance challenges [include] ... [1] Data access and vendor dependency.... [2] Identifying all applicable NQTLs.... [3] Explaining factors and evidentiary standards ... [4] Demonstrating operational compliance.... [5] Ongoing maintenance obligations.... [6] Fiduciary responsibility.... If this process appears to be complex and overwhelming, that’s because, quite honestly, it is."  MORE >>

Video with transcript. "TOAMS 6 is WTW's sixth edition of [this] mortality and policyholder behavior study, covering calendar years 2018-2022 with data from 1.1 million deaths and [is] the first edition to encompass the COVID-19 era. Using predictive analytics, [the study] uncovered key insights on COVID's impact, socioeconomic factors, risk class differentials and more that will help to shape smarter decisions across pricing and product development."  MORE >>

"The new rule reveals the administration's priorities, even as consumers' costs rise. It ratchets up scrutiny of the enrollment process and imposes administrative barriers it projects will cause up to 2 million people to lose coverage. At the same time, it relaxes standards for health insurers, greenlighting unprecedented flexibilities for companies to expose enrollees to massive out-of-pocket costs."  MORE >>