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Trial Court Vacates 2017 Rules Which Expanded Exemptions to Contraceptive Mandate
The ACA requires non-grandfathered medical plans to cover preventive services (including contraceptives) in-network without cost-sharing.
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In 2017, rules expanded exemptions for employers with religious or moral objections.
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SCOTUS upheld these rules in 2020.
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On August 13, 2025, a trial court (Pennsylvania v. Trump) vacated the 2017 rules as arbitrary and capricious.
WHO THIS APPLIES TO:
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Employers with non-grandfathered plans who object to contraceptive or sterilization coverage.
Practical Impact:
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Employers previously exempt under 2017 rules must now comply with the ACA mandate unless they qualify for narrow exemptions or follow an accommodation process.
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Exemptions remain for churches, integrated auxiliaries, and religious orders.
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Other religious nonprofits and closely held for-profits may use the accommodation process (self-certify via EBSA Form 700 or notify DOL/HHS).
Two groups (Assn. of Christian Schools International and Christian Employers Alliance) hold permanent injunctions against accommodation enforcement. Others must comply or litigate.
GO DEEPER:
Update on Two Tobacco Incentive Lawsuits
Two lawsuits show pitfalls with wellness programs tied to tobacco status:
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Chirinian v. Travelers: Employer failed to mention option to create a reasonable alternative with a personal physician in its SPD.
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Buescher v. North American Lighting: Employer did not adequately notify about a reasonable alternative.
WHO THIS APPLIES TO:
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Any employer with health plan incentives tied to tobacco status.
Practical Impact:
Employers must ensure plan materials include proper language, reasonable alternatives, and required notices to avoid litigation.
GO DEEPER:
Court Issues a Stay on Several Provisions of the June 25 ACA Final Rules
A federal court in Maryland (Aug 25, 2025) stayed parts of the June 25 ACA final rule.
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OOP limits for 2026 remain $10,600 per person / $21,200 per family.
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Proposed actuarial tolerance changes for Exchange plan metal levels were blocked.
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Other changes (special enrollments, tax credits) do not directly affect employers.
WHO THIS APPLIES TO:
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No direct impact to employers; no action needed.
GO DEEPER:
ACA FAQs Part 71
Released July 30, 2025:
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Clarifies calculation of QPAs under the No Surprises Act.
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Enforcement relief allows use of 2021 QPA rules for services before Feb 1, 2026.
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Reminds employers of 2026 OOP limits ($10,600 / $21,200).
WHO THIS APPLIES TO:
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All employers sponsoring medical plans (No Surprises Act).
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All employers with non-grandfathered medical plans (OOP).
GO DEEPER:
Non-Enforcement of Short-Term Limited Duration Insurance (STLDI) 2024 Rule
On Aug 7, 2025, the federal government said it will not enforce 2024 STLDI rules.
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Primarily affects the individual insurance market.
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Minimal employer impact (only when STLDI loss triggers a qualifying event for group coverage).
GO DEEPER:
HOT TOPIC: MLR Rebates Reminder for Employers
Carriers must send Medical Loss Ratio (MLR) rebate checks by Sept 30.
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If plan document states rebates belong to employer → employer may keep rebate.
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Otherwise, employee-paid share is considered “plan assets” and must be returned to participants.
Methods:
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Taxable cash refund.
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Premium holiday.
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Benefit enhancement (within 90 days).
WHO THIS APPLIES TO:
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Any employer with a fully-insured plan in the prior year.
GO DEEPER:
Annual Medicare Part D Notices Due by October 15
Employers must notify all Medicare-eligible individuals about creditable or non-creditable prescription drug coverage.
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Applies to actives, COBRA, and retirees.
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Notices can be provided by mail, in-person, or electronically (if DOL e-disclosure rules met).
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If a plan will lose creditability Jan 1, disclose this before Oct 15.
WHO THIS APPLIES TO:
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All employers with prescription drug coverage.
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Employers with ICHRAs reimbursing prescription expenses.
GO DEEPER:
FAQ: Court Orders & Benefit Eligibility for Spouses/Dependents
Employers must carefully handle changes related to:
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Spouse citizenship/residency – usually no mid-year qualifying event.
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Legal separation – often not a qualifying event unless plan terms specify.
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Court-ordered former spouse coverage – usually COBRA required, not active coverage.
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Custody orders – must specify insurance coverage to be a qualifying event.
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QMCSOs/NMSNs – require prompt employer action per procedures.
Practical Implication:
Employers should consult counsel, comply with COBRA, and remind employees not to make election changes without legal confirmation.