Insights

All policies issued or renewed in Oklahoma on or after November 1, 2025, must comply with the cancer testing provisions of SB 109. Specifically, a group health insurance policy must provide coverage for clinical gene testing of inherited gene mutations for individuals with a personal or family history of cancer. Further, the test must be ordered or recommended by a healthcare provider in accordance with the most recent version of the NCCN clinical practice recommendations that are Category 2A o

All policies issued or renewed in Oklahoma on or after November 1, 2025, must comply with the contraceptive coverage requirements of SB 176. Specifically, a group health insurance policy that already offers coverage for contraceptive drugs must provide enrollees with the option to receive a three-month supply of a contraceptive drug the first time it is prescribed. For each subsequent time the enrollee receives the contraceptive drug, they must be able to receive a six-month supply. An enrollee

All policies issued or renewed in Oklahoma on or after November 1, 2025, must comply with the healthcare payment provisions of SB 515. Specifically, if an enrollee negotiates a lower-than-average fee for a covered healthcare service and chooses to pay directly out of pocket for that service to the healthcare provider, the health insurance policy must count that amount toward the enrollee’s annual deductible and out-of-pocket limits under the policy if certain conditions are met. The healthcare

On June 20, 2025, Gov. Abbott signed SB 1188 into law. The new law relates to electronic health records and requires that electronic health records under the control of a covered entity that contain patient information must be physically maintained in the U.S. or a U.S. territory, and that electronic health record information is accessible only to those who require the information to perform duties within their employment related to treatment, payment, or healthcare operations. A covered entity

On August 29, 2025, the North Carolina Department of Insurance released Bulletin Number 25-B-11 regarding short-term, limited duration (STLD) health insurance policies. The bulletin advises that North Carolina’s definition of short-term limited duration health insurance policies continues to align with the current federal definition of such policies as currently provided in 45 C.F.R. Section 144.10 and that no STLD product regulated by the Department of Insurance may be offered in North Carolin

On August 29, 2025, the New York Department of Financial Services (NY DFS) announced its decision concerning the applicable premium rate and maximum employee contribution for New York Paid Family Leave (NY PFL) coverage beginning January 1, 2026. Effective January 1, 2026, the PFL rate will be set at 0.432% of an employee's salary per payment period up to and not exceeding a maximum annual employee contribution of $411.91. If an employee's contribution reaches the maximum annual employee contri

In 2024, Gov. Pritzker signed HB 5258, which expands dependent coverage status to a parent or stepparent in certain circumstances for fully insured plans issued in Illinois. The effective date of this bill is January 1, 2026, so it is an important reminder for employers who sponsor health plans in Illinois. The bill expands the definition of dependent to include the parent or stepparent of the insured only if the parent or stepparent meets the definition of a qualifying relative under IRS

A recently filed putative class action lawsuit, Barbich et al v. Northwestern University et al, raises concerns that a new wave of ERISA fiduciary breach claims may be on the horizon. In Barbich, the plaintiffs allege that Northwestern University, as the group health plan sponsor, breached its fiduciary duties by failing to prudently select and monitor their medical plan options and by not disclosing material plan information to participants. The case, which was filed in the federal district co

On August 26, 2025, the Fifth Circuit Court of Appeals remanded Braidwood Management Inc. v. Becerra, Inc. back to the district court for further proceedings. The Fifth Circuit made this move in response to the recent Supreme Court ruling in this case. Background The Braidwood case concerns the ACA’s preventive care mandate. Under the ACA, insurers and group health plans offering non-grandfathered individual or group health coverage must cover certain preventive services without cost-sharing. T