State Updates
Latest State Updates
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 plans governed by state laws should be aware of these mandates and can contact their carrier for further details.
Read the full standing order here: COVID-19 Vaccine Standing Order
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 review their policies and payment standards to ensure that ground ambulance claims are processed in compliance with these Utah laws.
Employers with plans governed by state laws should be aware of these mandates and can contact their carrier for further details.
Read the bulletin here: Utah Bulletin 2025-9
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, provider, pharmacy, pharmacy services administration organization, or other healthcare benefit manager, entered directly or indirectly in support of a contract with a carrier or employee benefits programs.
HCBMS are generally defined by Washington mandates as a person or entity providing services to, or acting on behalf of, a health carrier or employee benefits programs, that directly or indirectly impacts the determination or utilization of benefits for, or patient access to, healthcare services, drugs, and supplies.
The TAA provides guidance on several points, including:
- Entities that are not included in the definition of HCBMs. For example, an employer administering its employee benefit plan or the employee benefit plan of an affiliated employer under common management and control.
- That HCBM requirements are inapplicable to persons or entities providing services to, or acting on behalf of, a union or employer administering a self-funded group health plan governed by the provisions of ERISA unless the self-funded private group health plan chooses to participate. The OIC will implement an opt-in process during Fall 2025 and make a list of the health plans that have opted in available on its website by December 1, 2025.
Employers with plans governed by state laws should be aware of these mandates and can contact their carrier for further details.
Read the full advisory here: Technical Assistance Advisory 2025-02 - OIC's Interpretation of Chapter 48.200 RCW – Healthcare Benefit Managers
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 a carrier's covered formulary drug list.
If an exception request is granted, the carrier must treat the excepted drugs as an essential health benefit, including counting any cost-sharing towards the plan's annual limitation. The rule change also updates a link to the department's website, where consumers can find information about independent reviews.
Employers with plans governed by state laws should be aware of these mandates and can contact their carrier for further details.
Find more details on the mandate updates here: R590-261 Health Benefit Plan Adverse Benefit Determinations
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 vaccines and their administration under Bulletin No. DFR 2021-1 is in addition to any coverage requirements that may apply to a health benefit plan under state or federal law.
- A health benefit plan may not impose any cost-sharing requirements, such as a copay, coinsurance, or deductible, or restrict coverage to in-network providers in accordance with Bulletin No. DFR 2021-1.
In addition to these bulletins, the DFR has a standing FAQ on insurance coverage for COVID-19 vaccines.
Employers with plans governed by state laws should be aware of these mandates and can contact their carrier for further details.
Read the full bulletin here: Oregon Bulletin No. DFR 2025-6
Last month, the New Jersey Department of Banking and Insurance issued guidance directed at health insurers regarding coverage of COVID-19 vaccines. The bulletin “strongly encourages” insurers to continue coverage of the vaccine without cost-sharing and without a prescription for all individuals ages 6 months and older.
The bulletin was issued amid a gap in guidance from federal regulators. This season's COVID-19 vaccines were approved by the Food and Drug Administration (FDA) in August, but with new restrictions on eligibility. For the first time, the updated shots are approved only for those ages 65 and older or at high risk of severe illness. Historically, the Centers for Disease Control (CDC) has issued guidance on administering the vaccines within days of its approval by the FDA. The CDC 2024-2025 COVID shot was recommended by the CDC for “most adults ages 18 and older.” However, guidance for this year's booster has yet to be published. The lack of guidance from the CDC leaves the issue of how exactly the shots will be covered by insurance plans in limbo.
The bulletin calls on insurers to update plan documents and clearly communicate how participants can access covered benefits for vaccines. However, the bulletin stops short of issuing a coverage mandate.
Group health plan sponsors with policies issued in New Jersey should contact their insurer to learn how the 2025-2026 COVID-19 shot will be covered by their policy — including whether there will be any out-of-pocket cost, whether a doctor's office visit or a prescription will be required, and whether there are any age or other eligibility restrictions associated with the vaccine's coverage.
Read the guidance here: NJDOBI | NJ Department of Banking and Insurance Issues Guidance on Coverage of COVID-19 Vaccines
The Massachusetts Department of Family and Medical Leave announced the premium rates and maximum weekly benefit amount for the Massachusetts Paid Family and Medical Leave (MA PFML) program beginning January 1, 2026.
The total 2026 MA PFML premium contribution for employers with 25 or more employees who work in Massachusetts is 0.88% of eligible wages. For employers with fewer than 25 employees who work in Massachusetts, the 2026 MA PFML premium contribution is 0.46% of eligible wages. The employee's contribution share is 0.46% of eligible wages (0.28% for medical leave and 0.18% for family leave) in 2026. For employers with 25 or more employees in Massachusetts, the employer contributes the difference between the total premium and employee contributions. For employers with 25 or fewer employees in Massachusetts, no employer contribution is required. Individual contributions are capped by the Social Security taxable maximum. The maximum weekly benefit an eligible employee can receive in 2026 is $1,230.39, an increase from the 2025 maximum of $1,170.64.
MA PFML applies to most employers, including out-of-state employers, with at least one employee working in Massachusetts. Additionally, it provides eligible employees with a portion of their wages while taking time off to bond with a child, care for a family member with a serious health condition, or handle personal matters when a family member is deployed abroad on active military service.
Employers with employees in Massachusetts should ensure that their MA PFML payroll systems and MA PFML policies and communication materials reflect these new changes.
See the employer contribution rates and more details here: PFML Contribution Rates and Calculator
In 2024, California's legislature passed Senate Bill (SB) 729. As noted in our prior Compliance Corner article, SB 729 was originally scheduled to take effect on July 1, 2025. However, Gov. Newsom requested that the effective date be postponed to plans issued, amended, or renewed on or after January 1, 2026. Importantly, that delay was officially enacted through Assembly Bill (AB) 116, signed by Gov. Newsom on June 30, 2025, as part of the state's budget agreement.
SB 729 mandates that fully insured group health plans, state-regulated health plans, and disability insurance provide coverage for infertility diagnosis and treatments, such as in vitro fertilization (IVF). This includes up to three oocyte retrievals and unlimited embryo transfers.
Under SB 729, large group plans are required to provide mandatory coverage for the services mentioned. However, small group plans (defined in California as those with 100 or less full-time equivalent employees) must offer participants the option to purchase infertility coverage as an additional benefit — rather than covering these by default.
Self-insured and level-funded ERISA plans may voluntarily comply with SB 729's mandates. Employers with plans governed by state laws should be aware of these mandates and can contact their carrier for further details.
Read the bills in full below:
In September 2025, Gov. Hobbs signed several Executive and Standing Orders directing the Arizona Department of Health Services (ADHS) to make COVID-19 vaccines broadly accessible. Recently, the FDA approved the 2025-2026 COVID-19 vaccine for individuals aged 65 and older, as well as those at high risk of severe illness. However, the Arizona orders expand eligibility to anyone aged 6 months and older. More specifically, the orders include the following notes on administering the vaccines:
- Healthcare providers (excluding pharmacies) can vaccinate children aged 6 months to 6 years.
- Healthcare providers and pharmacies can vaccinate individuals 6 years and older without a prescription.
- Participation by pharmacies and insurance coverage may vary — and are not guaranteed.
More information about the standing order is available on the ADHS website. For example, its vaccine page indicates that insurance coverage for COVID-19 vaccination may depend on preventive service recommendations from the federal Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP).
Employers with plans governed by state laws should be aware of these mandates and can contact their carrier for further details.
Read the executive and standing order in full below:
On July 30, 2025, Gov. Newsom signed AB 951 into law. The new law prohibits health insurers from requiring an enrollee previously diagnosed with pervasive developmental disorder or autism to receive a rediagnosis to maintain coverage for behavioral health treatment. Further, insurers cannot discontinue or delay existing treatment while waiting for a rediagnosis. The treating providers should provide the treatment plan to insurers upon request. The law is effective for policies issued or renewed on or after January 1, 2026.
Existing law requires fully insured group health policies issued in California to provide coverage for behavioral health treatment for pervasive developmental disorder or autism. Insurers are responsible for bringing applicable fully insured plans into compliance. Employer plan sponsors should be aware of the changes.
Read the full legislation: AB 951.
All policies issued or renewed in Oklahoma on or after November 1, 2025, must comply with the anesthesia coverage provisions of SB 1019. Specifically, a group health insurance policy may not impose a time limit on the amount of covered anesthesia services provided during a medical or surgical procedure, or restrict or exclude coverage of anesthesia time. Anesthesia time is defined as the period beginning when the patient is prepped by the anesthesia practitioner for anesthesia services and ending when the services are no longer furnished to the patient.
Insurers are responsible for bringing applicable fully insured plans into compliance. Employer plan sponsors should be aware of the changes.
Read the full provisions: SB 1019.
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 or higher, or in accordance with other nationally recognized clinical practice guidelines. The coverage must not be subject to any deductibles, copayments, or coinsurance.
Insurers are responsible for bringing applicable fully insured plans into compliance. Employer plan sponsors should be aware of the changes.
Read the full legislation: SB 109.
NFP Corp. and its subsidiaries do not provide legal or tax advice. Compliance, regulatory and related content is for general informational purposes and is not guaranteed to be accurate or complete. You should consult an attorney or tax professional regarding the application or potential implications of laws, regulations or policies to your specific circumstances.