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Does Your Plan Have an Updated HIPAA Notice of Privacy Practices?

"Although the part of the 2024 Privacy Rule pertaining to reproductive disclosures was struck down by a Texas court, a portion of the Rule survived. The surviving portion of the regulations requires covered entities to update their HIPAA Notice of Privacy Practices to add provisions on the confidentiality of medical records relating to individuals with substance use disorders (Part 2 Rule) by February 16, 2026."

Post-Annual Enrollment Check-In: Correcting Election Mistakes

"There are a variety of mistaken elections that can occur each year. They may be made by employees out of confusion, the result of bad programming in the enrollment platform, or mistaken paper election.... [This article discusses] the parameters of correcting cafeteria plan elections."

Shifting Federal Vaccine Guidelines Spark State Reactions and New Mandates

"In September, the Advisory Committee on Immunization Practices (ACIP) ... changed its recommendations regarding several vaccines ... Although the updated recommendations have not been published in the ACIP Morbidity and Mortality Weekly Report (MMWR), the CDC immunization schedules for both COVID-19 vaccination and MMRV were updated October 7, 2025 with adopted changes to recommendations. Plan years beginning on or after October 7, 2026, must comply with the new recommendations ... (January 1, 2027 for calendar year plans)."

Post Annual Enrollment Check-In: Becoming an ALE

"Plan eligibility and the annual enrollment process becomes of utmost importance when an employer becomes an [ALE] ... For employers that hover around a 50-employee threshold, ALE status can fluctuate from year to year. [This article discusses] the important aspects of an ALE status and how to mitigate potential penalties."

New California PBM Law Takes Effect in 2026

"Provisions that relate specifically to PBM business practices generally take effect on January 1, 2026, while those that will impact fully insured plans take effect on contracts issued, amended, or renewed on or after January 1, 2026.... [T]he law contains an express exemption to PBMs when providing services to self-insured multiemployer union (Taft Hartley) plans subject to ERISA."

Post Annual Enrollment Check-In: New Vendors

"[P]lan sponsors often make changes year to year, and those changes require additional administrative action on the sponsor's part.... For group health plans, it includes obligating those vendors to comply with HIPAA, ACA, and transparency. Before you sign the contract, ensure that the important compliance requirements a plan cannot perform alone are considered in the contract. And, at the end of the process, do not forget to amend internal documents and policies, as needed, to reflect the changes."

Reminder: Gag Clause Prohibition Compliance Attestation Changes in 2025

"Fourth quarter compliance activities have included the gag clause prohibition compliance attestation for the third year in a row. This year, there are important changes ... including the requirement to confirm the absence of gag clauses in your insurer or third party administrator's downstream agreements with other third parties, such as their network providers. The attestation is due by December 31. "

DOL Restarts Self-Audit Program for FLSA and FMLA Violations

"Affected employees identified in the self-reported claim will be provided with a PAID Acceptance Letter outlining the violations and the back wages or remedies owed. If the affected employee accepts the settlement terms, they will forfeit their right to further litigation for the specific violations outlined in the letter.... Employees do not have to accept the settlement and can retain their right to civil litigation for the identified violations."

A Balancing Act: State PBM Laws and ERISA Preemption (PDF)

"For now, we know that Rutledge does not preempt PBM regulations that merely increase the cost of doing business in the state. Mulready preempts plan design requirements, including network adequacy, in PBM laws in the 10th Circuit, but network considerations are likely not preempted pursuant to Wehbi in the 8th Circuit. Finally, Gobeille provides an argument that ongoing reporting and attestations are preempted.... [T]he only thing that is clear is that PBM laws that merely increase plan costs, without more, are not preempted. Most other types of provisions ... are still up for debate."

Preparing for 2025: Creditable Coverage Changes and Medicare-Eligible Employees

"It will be more difficult for HDHP prescription drug coverage to be considered creditable coverage. Other plans with high deductibles will also be impacted.... Medicare-eligible employees that do not enroll in Medicare Part D during their initial enrollment period and fail to maintain creditable coverage will incur a late enrollment penalty if the gap is 63 days or more."