Compliance Corner Archives

On December 9, 2025, the IRS released IRS Notice 2026-5, which offers guidance regarding modifications to HSAs instituted by the One, Big, Beautiful Bill Act (OBBBA), enacted on July 4, 2025. These changes involve telehealth services, bronze and catastrophic plans, and direct primary care service arrangements (DPCSAs).  Telehealth Services  The OBBBA permanently allows group health plans to offer telehealth services to HDHP participants before deductibles are met, without affecting HS

On November 26, 2025, in the closely followed case of Lewandowski v. Johnson & Johnson, et al., a New Jersey district court dismissed two amended ERISA fiduciary breach claims filed against defendant Johnson & Johnson, in its capacity as group health plan sponsor, and its benefit committee (collectively, J&J). The court determined that the participant plaintiffs had (once again) failed to establish legal “standing” to proceed with the claims. The ruling is good news for J&J and

On November 12, 2025, the longest government shutdown in U.S. history finally ended. During the shutdown, executive agency activity slowed, or ceased, impacting employers in a variety of ways. From an employee benefits perspective, the release resulted in a delay of agency guidance, including important healthcare transparency rules. However, transparency, particularly regarding prescription drug coverage, remains a priority of the Trump administration. Accordingly, now that government operation

On November 12, 2025, President Trump signed the Continuing Appropriations and Extensions Act of 2026, effectively ending the 43-day federal government shutdown. The stopgap bill temporarily extended funding for most of the federal government through January 30, 2026. Notably, though, the bill did not include any extension of the ACA enhanced premium tax credits (PTCs), which was the central issue during the shutdown. However, the parties tentatively agreed to vote on the outcome of the enhance

On November 3, 2025, the IRS released Notice 2025-61, which announces that the adjusted applicable dollar amount for calculation of PCOR fees for plan and policy years ending on or after October 1, 2025, and before October 1, 2026, is $3.84. This is a $0.37 increase from the $3.47 amount in effect for plan and policy years ending on or after October 1, 2024, and before October 1, 2025.  PCOR fees are payable by insurers and sponsors of self-insured plans (including level-funded plans, HRAs

The IRS recently issued Revenue Procedure 2025-32, providing certain cost-of-living adjustments for a wide variety of tax-related items, including health FSA contribution limits, transportation and parking benefits, qualified small employer health reimbursement arrangements (QSEHRAs), the small business tax credit, and other adjustments for tax year 2026. Those changes are outlined below.  Health FSA: The annual limit on employee contributions to a health FSA will be $3,400 for plan years

On October 16, 2025, the DOL, HHS, and Treasury (collectively, the departments) released new guidance in the form of FAQs regarding fertility benefit offerings. The guidance was issued in response to President Trump’s Executive Order 14216, "Expanding Access to In Vitro Fertilization," which called for recommendations to protect in vitro fertilization (IVF) access and reduce out-of-pocket and health plan costs for IVF treatment. Specifically, the FAQs clarify the types of “excepted benefits” em

The Affordable Care Act (ACA) enhanced premium tax credits (PTCs) are set to expire at the end of 2025, absent additional congressional action. Employers may question whether the expiration will impact their group health plans.   Background   Initially enacted in 2014, the PTC was established to help eligible individuals lower their premium payments for plans offered through the health insurance exchanges (marketplace) created under the ACA. The ACA marketplace determines how much enr

As October is Breast Cancer Awareness Month, employers that sponsor group health plans should be aware of the expanded breast cancer screening benefits that are scheduled to take effect in 2026. Background The ACA requires non-grandfathered group health plans (whether fully insured or self-insured) to cover certain preventive care in-network without cost-sharing (including deductibles, copayments, or coinsurance). The required covered care includes services given an “A” or “B” rating from the U

On August 25, 2025, a U.S. District Court denied a motion to dismiss a class action lawsuit against Kaiser Foundation Health Plan Inc. (KFHP) for its denial of coverage for prescription hearing aids, in violation of Section 1557 of the ACA. Specifically, the court found the plaintiff had standing to bring the lawsuit and adequately alleged that the plan's coverage exclusion was discrimination under the ACA. Background The plaintiff in the case was an enrollee in a health plan administered by Ka

On September 9, 2025, the Eleventh Circuit Court of Appeals held in Lange v. Houston County that a plan that did not cover gender affirming surgery did not violate Title VII of the Civil Rights Act of 1964 (Title VII). Background The plaintiff in the case worked for the defendant as a deputy sheriff. They are transgender and sought gender affirming surgery (as well as the drugs, services, and supplies that went along with it). However, the defendant's plan did not cover those products or servic

On September 2, 2025, a U.S. District Court in Illinois dismissed an ERISA preemption lawsuit by Central States, Southeast, and Southwest Areas Health and Welfare Fund against the Arkansas Insurance Commissioner and Department. Specifically, the plaintiff (a self-funded, multiple employer welfare plan) challenged an Arkansas state rule that permits the Arkansas Insurance Commissioner (the commissioner) to review the adequacy of pharmacy reimbursement payments made by health plan PBMs, arguing t