On July 28, 2025, in Express Scripts, Inc. et al v. Richmond et al, the United States District Court for the Eastern District of Arkansas granted the plaintiffs’ motion for a preliminary injunction to prevent enforcement of Arkansas Act 624, which restricts pharmacy benefit managers (PBMs) from owning and operating pharmacies in the state. The court agreed with the...

On August 6, 2025, the IRS issued a reminder that principal and interest charges on employees’ qualified education loans are eligible expenses under educational assistance programs. Employers can either reimburse the employee or pay the lender directly for qualified education loan expenses up to the $5,250 annual limit. Note that other eligible expenses include items such as...

On August 4, 2025, the Ninth Circuit Court of Appeals held that an employer cannot unilaterally impose arbitration provisions on plan participants through plan amendments. Specifically, the court held that employers cannot bind participants to arbitrate ERISA claims without their express consent and that the plaintiff in the case had not agreed to arbitrate ERISA claims as required...

On July 18, 2025, the IRS published Revenue Procedure 2025-25, which announces the ACA affordability percentage (termed the required contribution percentage) for medical plan years beginning in 2026. Under the ACA employer-shared responsibility rules (also known as the employer mandate), an applicable large employer (ALE) must provide affordable, minimum-value coverage to its full-time employees or risk being subject to penalties (An ALE is an employer that employed at least 50 full-time employees, including full-time equivalent employees, on average during the prior calendar year)...

On July 22, 2025, the IRS released Revenue Procedure 2025-26, which in part provides indexing adjustments for penalties under the ACA employer mandate. The ACA requires applicable large employers (ALEs), those with 50 or more full-time employees and full-time equivalent employees, to offer affordable minimum value (MV) coverage to all full-time employees and their dependents or risk a penalty. Notably, the employer mandate penalty amounts for 2026 are increased from the 2025 penalty amounts. For plan years beginning on or after January 1, 2026, the annual penalties...

On June 20, 2025, CMS issued the “Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability Final Rule.” The rule makes several changes to annual cost-sharing limits and the definition of essential health benefits. The rule updates the methodology for calculating the “premium adjustment percentage,” which results in a revision of the previously announced maximum annual limit on cost-sharing for 2026 (which we originally reported on in an article in the October 22, 2024, edition of Compliance Corner). The maximum annual limit is now...

On June 16, 2025, in J.H. et al v. United Behavioral Health et al, the United States District Court for Utah ruled that the defendant insurer’s decision to deny residential treatment benefits for an ERISA plan participant was arbitrary and capricious. The court granted summary judgment to the plaintiffs and remanded the case back to the insurer for reconsideration of the denied claims.

On July 4, 2025, President Trump signed the One Big Beautiful Bill Act (OBBBA) into law. While the final bill omitted several of the benefit provisions included in the initial House legislation, it includes some noteworthy changes for employers as group health and welfare plan sponsors.

On July 1, 2025, the Senate narrowly approved its amended version of the One Big Beautiful Bill Act (OBBBA), clearing the way for a vote in the House of Representatives. Significantly, for group health and welfare plan sponsors, the Senate measure includes several noteworthy provisions. Specifically, the...

On June 27, 2025, the U.S. Supreme Court announced its long-awaited opinion in Kennedy v. Braidwood Management, Inc., which challenged the legality of ACA preventive care coverage requirements. The Court ruled that members of the U.S. Preventive Services Task Force (USPSTF), an HHS entity that makes evidence-based recommendations regarding preventive healthcare services, were properly appointed under the U.S. Constitution. As a result, group health plans must continue to cover all ACA-required preventive care without...