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Proposed HHS Regs on Transitional Reinsurance Program Premiums Will Affect Health Plans

"The reinsurance programs are intended to help stabilize premiums for coverage in the individual market during the first three years the state health insurance exchanges are operational (2014 through 2016). HHS is estimating the annual contribution rate for 2014 will be $63 per covered life (employees and their dependents). This will undoubtedly impact the overall cost of providing coverage under an employer-sponsored group health plan and should be taken into account by employers for purposes of estimating cost trends."

IRS Private Letter Ruling Will Help Clear the Way for 401(k) Plan Student Loan Benefits

"[T]he IRS concluded that the employer could make a non-elective contribution to its 401(k) plan, where the amount of the non-elective contribution would be based on an employee's total student loan repayments and would be contributed to the plan in lieu of the matching contributions that would otherwise be made to the plan had the employee made pre-tax, Roth 401(k) and/or after-tax contributions. The student loan benefit program detailed in [PLR 201833012] includes a number of key features[.]"

New Law Will Have Significant Impact on Group Health Plans Insured in New York (PDF)

2 pages. Excerpt: [Significant group health plan legislation was passed by the New York] legislature and signed by Gov. David A. Paterson on July 29. The new legislation will extend dependent coverage and expand Consolidated Omnibus Budget Reconciliation Act (COBRA) protections to health plan participants in the state, and may raise interesting questions in its coordination with the federal COBRA statute.

Medicare Secondary Payor Reporting Requirements Will Affect Self-Insured Health Care Providers, Captive Insurers

Excerpt: Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 added new mandatory reporting requirements for insurers that will now enable CMS to ensure that it has the necessary information to determine when Medicare's financial responsibility is secondary.

IRS Announces 2026 Limits for HSAs, HDHPs, HRAs

"All of the dollar limits currently in effect for 2025 will change for 2026, with [one] exception ... The HSA catch-up contribution for individuals ages 55 and older will not change as it is not subject to cost-of-living adjustments.... [A table] compares the applicable dollar limits for HSAs, HDHPs, and excepted benefit HRAs for 2025 and 2026."

OBBBA's Impact on Employee Benefit Plans, Programs, and Arrangements

"[P]lan sponsors should consider the following measures ... [1] Reevaluate dependent care FSAs.... [2] Consider retroactively or prospectively reinstating first-dollar telehealth and other remote-care service coverage under HDHPs.... [3] Identify whether to adopt or further explore [direct primary care] arrangements.... [4] Review current or potential employer-provided childcare programs in light of expanded tax credits.... [5] Evaluate and make any required updates to plan documents in light of the OBBBA and any changes adopted."

Vermont Enacts New Telehealth Legislation Impacting Insurers

"The legislation, which goes into effect on September 1, 2025, requires that health insurance plans provide coverage for healthcare and dental services delivered through telemedicine to the same extent as if the services were provided through in-person consultations."

Cadillac Tax Delayed to 2020; Health Plan Information Reporting Due Dates Extended

"The indexing under the Cadillac Tax will continue while the tax is delayed so that the dollar limits in effect in 2020 will reflect application of indexing had the delay not been enacted. Of perhaps greater significance, the Act makes the Cadillac Tax deductible which will lessen the impact of the tax for certain employers.... [T]he IRS noted that employers and other coverage providers that do not meet the extended due dates [for ACA reporting] are still encouraged to furnish and file, and the IRS will take such steps into consideration when determining whether to abate penalties for reasonable cause.... The IRS also noted that it will take into account the extent to which the employer or other coverage provider is taking steps to ensure that it is able to comply with the reporting requirements for 2016."

PBMs Score a Win in Federal Court Against State Regulation

"[T]he McKee court held that Tennessee's 'any willing pharmacy' law had an impermissible connection with ERISA plans and was therefore preempted. In so holding, the court rejected the state of Tennessee's reliance on Rutledge. Critically, Rutledge involved a form of cost regulation, not plan structure. By contrast, pharmacy networks -- at issue in McKee -- are plan structures." [McKee Foods Corporation v. BFP Inc., No. 21-0279 (E.D. Tenn. Mar. 31, 2025)]

Reproductive Health Under the Trump Administration So Far

"Over the past two months, the second Trump administration has shifted federal policies and priorities regarding abortion, in vitro fertilization (IVF), contraception, and other reproductive-health-related matters -- and it is expected to continue to do so. In addition to the federal policy agenda, many developments related to reproductive health likely will continue to occur at the state level.... This article discusses some of the major recent trends in women's health and reproductive health, and what is likely to come next under the new administration."