Insights

Take action to support menopause care at work as policy shifts drive new expectations for coverage, training and workplace accommodations.

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 4, 2025, the Washington Department of Health (DOH) issued a standing order expanding access to COVID-19 vaccines. The order allows most residents to receive a COVID-19 vaccine directly from pharmacies, clinics, or other qualified providers without needing a doctor's prescription. The order applies to all Washington residents 6 months and older, regardless of health status (e.g., pregnant and/or high-risk). The DOH also created an FAQ to accompany the standing order. Employers with

On September 23, 2025, the Utah Department of Insurance (DOI) issued Bulletin 2025-9. The bulletin provides guidance on House Bill (HB) 301, passed during the 2025 Utah General Legislative Session regarding rates for ground ambulance charges by an ambulance provider. The bulletin reiterates the requirement for insurers to calculate the allowable amount no less than the base rate, medication maximum cost, and mileage rate established by HB301. In addition, the bulletin encourages insurers to rev

Spousal surcharges and carve-outs are becoming more popular as employers try to implement cost-saving methods in the face of rising renewal costs. Some employers implement a spousal surcharge, which sets out to deter enrollment of spouses by imposing higher spousal premiums, while others implement a spousal carve-out that renders spouses ineligible to enroll if certain conditions are met. Both of these strategies come with compliance concerns, and employers should work closely with their own le

On September 15, 2025, the Washington Office of Insurance (OIC) Commissioner issued Technical Assistance Advisory 2025-02. The Technical Assistance Advisory (TAA) provides guidance on Washington's healthcare benefit manager (HCBM) mandates. Under Washington law, HCBMs are required to initially register with the OIC commissioner and annually renew their registration. HCBMs also must file with the OIC all benefit management contracts and contract amendments between the HCBM and a health carrier,

On August 7, 2025, the Utah Department of Insurance (DOI) finalized changes to R590-261 Health Benefit Plan Adverse Benefit Determinations. The changes introduce a new section that specifies that a carrier must provide an exception process for non-formulary drugs that comply with the federal law outlined in 45 CFR 156.122. That federal section requires a process for an enrollee, designee, or prescribing provider to request review of, and access to, a clinically appropriate drug not included on

On September 17, 2025, the Oregon Division of Financial Regulation (DFR) issued Bulletin No. DFR 2025-6, reiterating its existing expectations of COVID-19 vaccination coverage by health benefit plans in Oregon. The bulletin emphasizes that: All health benefit plans (including grandfathered health benefit plans) in Oregon must provide coverage for FDA-approved COVID-19 vaccines and their administration in accordance with the previously issued Bulletin No. DFR 2021-1. The requirement to cover va