State Updates

On September 11, 2025, the Colorado Division of Insurance (DOI) adopted Emergency Regulation 25-E-04 requiring carriers to cover COVID-19 vaccines as a preventive service without cost-sharing. This regulation aligns with Public Health Order 25-01, issued September 3, 2025, which authorizes trained healthcare professionals – such as nurses and pharmacists – to administer vaccines under protocol. The Public Health Order also allows Coloradans to receive vaccines from participating providers and pharmacies without an individual prescription. However, costs may still apply based on a person’s insurance coverage.

On November 19, 2025, the DOI issued Bulletin B-4.155 regarding coverage of biomarker testing in health benefit plans. The Bulletin clarifies the DOI’s interpretation of existing coverage requirements on biomarker testing for diagnosis, treatment, appropriate management, and ongoing monitoring of a covered person’s disease or condition by articulating that:

• Coverage of biomarker testing is required for large group health benefit plans issued or renewed on or after January 1, 2025.
• Under 2024 Colorado Senate Bill 24-124, coverage for biomarker testing that is medically necessary and supported by medical/scientific evidence is required by all small group and individual plans. The DOI’s position is that these biomarker tests are not in addition to the benefits provided by Colorado’s benchmark plan.

The Bulletin notes that if the federal HHS Department later requires Colorado to defray additional costs, the DOI will notify the relevant state legislative health committees.

On November 19, 2025, the Colorado DOI also issued Bulletin B-4.154 concerning coverage of pediatric neuropsychiatric syndrome (PANs) and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAs) in health benefit plans. The Bulletin clarifies the DOI’s position on 2024 Colorado House Bill 24-1382 that:

• Coverage of the prophylaxis, diagnosis, and treatment of PANs/PANDAs is required for large group plans issued or renewed on or after January 1, 2025.
• Coverage for prophylaxis, diagnosis, and treatment with antibiotics, medication therapies, and behavioral health therapies to manage neuropsychiatric symptoms are required for small group and individual plans. However, coverage of treatment using intravenous immunoglobulin and plasma exchange is in addition to benefits in the state’s EHB benchmark plan and, therefore, individual and small group plans are not required to provide this coverage.

The Bulletin notes that if the federal HHS later requires Colorado to defray additional costs, the DOI will notify the relevant state legislative health committees.

Employers should be aware of the state coverage requirements and contact the carrier for further details.

For additional information, please see:

• Emergency Regulation 25-E-04 Concerning Coverage of COVID-19 Vaccines as a Preventive Service
• Public Health Order 25-01: Access to COVID-19 Vaccines
• Bulletin B-4.155 Concerning Coverage of Biomarker Tests in Health Benefit Plans
• Bulletin No. B-4.154 Concerning Coverage of PANs/PANDAs in Health Benefit Plans

Governor Josh Shapiro signed SB 88, a measure to expand coverage of breast cancer screenings into law on November 24, 2025. The new law amends Pennsylvania’s existing mandate to cover breast cancer screenings, which was outlined in the May 9, 2023, Compliance Corner article, “Coverage for Preventative Breast Cancer and Ovarian Cancer Screenings.” Designed to bring Pennsylvania’s existing law into compliance with recent changes to federal breast cancer screening guidelines published by the Health Resources and Services Administration, the new law will require coverage of supplemental breast cancer screenings and diagnostic tests and examinations without patient cost-sharing for women with an average or higher risk of developing breast cancer.

The new law will impact fully insured coverage issued or renewed in the state. While SB 88 will take effect in January 2026, it will not affect the coverage terms of policies in place on its effective date. Instead, it will affect coverage issued, approved, or renewed on or after July 24, 2026. Employers offering fully insured coverage issued in the state should be aware of the expansion of breast cancer screening coverage and refer to their carrier for additional information.

Read the full bill here: SB 88

On November 17, 2025, the Oregon Division of Financial Regulation, which includes the Insurance Department, approved Permanent Administrative Order ID 9-2025: List of Prosthetic and Orthotic Devices under Oregon SB 699 (2025). The Order:

• Establishes a list of prosthetic and orthotic devices consistent with Oregon Revised Statute 743A.145, such as any device for which CMS has established an L Code in the Healthcare Common Procedure Coding System Level II as of January 1, 2026, and any additional devices determined to be medically necessary and the most appropriate model that meets the medical needs of the insured for performing physical activities and maximizes the insured’s whole-body health.
• Prohibits internal or separate limits or caps on prosthetic and orthotic devices, except for the lifetime policy maximum when permitted by law.
• Defines the circumstances under which coverage for prosthetic and orthotic devices is provided through a managed care organization.

The effective date for the Order is January 1, 2026. For official text of the Order, please see: ID 9-2025: List of Prosthetic and Orthotic Devices under Oregon SB 699 (2025).

For more background on this and other 2025 legislative changes for employee benefits in Oregon, review our prior article, Oregon Governor Signs Various Healthcare Bills into Law, in Compliance Corner.

The District of Columbia has issued an updated maximum weekly benefit amount payable for the DC Paid Family and Medical Leave program (DC PFL), effective October 1, 2025. 

The district’s minimum wage was increased to $17.95/hour. As a result, the maximum weekly DC PFL benefit amount – which is calculated as 90% of the employee’s average weekly wage based on the statutory minimum wage – will increase to $1,190 per week from $1,153.  

Employers should be aware of the 2025-26 benefit increase and should visit the DC Paid Family Leave website for further information.

The NJ Department of Labor and Workforce Development (LWD) announced the 2026 Temporary Disability Insurance (TDI) and Family Leave Insurance (FLI) contribution rates and maximum weekly benefit amounts. Below are the 2026 contribution rates for employees who work in NJ:

As the chart above shows, in 2026, employees will be required to make contributions for TDI and FLI. Employers are not required to contribute to FLI. However, TDI requires employer contributions. The contribution rate for employers varies from 0.10% to 0.75% ($43.30 to $324.75) of the taxable wage base, which is $43,300 in 2025.

The 2026 maximum weekly benefit amount that eligible employees will receive under TDI is 85% of their average earnings, up to a maximum of $1,199 per week (increased from $1,081 per week in 2025).

TDI provides partial wage replacement to NJ employees who must stop working due to a physical or mental health condition or other disability unrelated to their work. FLI provides NJ employees with partial wage replacement when they take time off to bond with a newborn, newly adopted, or placed foster child; to provide care for seriously ill or injured family members; or to handle certain matters related to domestic or sexual violence. (See the definition of family members for NJ FLI.)

Employers should be aware of the 2026 contribution rates and should visit the NJ TDI and FLI Program website for further information regarding these benefits. For more information, please ask your broker or consultant for a copy of the NFP publication State PFML and Statutory Disability Programs: A Quick Reference Chart.

Gov. Kathy Hochul has announced the launch of the latest phase of New York State’s Secure Choice Savings Program, a state-sponsored savings vehicle for private-sector employees who lack access to a retirement plan at work. This program, the 14th state-facilitated retirement savings program in the country, provides automatic enrollment and payroll deductions for New York employees to build their own Roth IRA. 

New York State’s Secure Choice Savings Program was created in the 2018-19 state budget as a voluntary option and modified in 2021 with a bill that made participation mandatory for certain covered employers. However, enrollment in the program remained voluntary until a governing board and administrative framework could be established. Fast forward to Fall 2025, when the state has announced it will begin notifying employers required to facilitate the program with registration details. Employers are required to participate if they: 

• Have been in business for at least two years.  
• Had at least 10 employees in the previous calendar year. 
• Do not offer a qualified retirement plan. 

Employers required to facilitate the program will have staggered registration deadlines, based on employee headcount. 

• 30 or more employees — must register by March 18, 2026. 
• 15 to 29 employees — must register by May 15, 2026. 
• 10 to 14 employees — must register by July 15, 2026. 

Employees will be automatically enrolled in the New York Secure Choice Savings program at a default savings rate of 3% of their gross pay, although participation is ultimately voluntary. Therefore, employees may choose to stay automatically enrolled or opt out and re-enroll later and can adjust their contribution rate at any time. Employers are neither required nor permitted to match employee contributions to the program. 

All New York employers should be on the lookout for notification from New York Secure Choice, whether required to participate or to certify exemption from the program when a qualified retirement plan is already being offered to employees. 

Read the New York State Secure Choice Savings Program's Overview & Registration and Employer Fact Sheet for more information.  

The Washington Employment Security Department announced that the 2026 Washington Paid Family and Medical Leave program total premium rate will increase from 0.92% to 1.13% of wages beginning January 1, 2026.  

Employers with 50 or more employees working in the state of Washington will contribute up to 28.57% of the total premium, and their Washington state employees will pay 71.43%. Employers with fewer than 50 employees working in the state of Washington are not required to contribute the employer portion of the premium. However, they must still withhold the employee premium or pay the employees' premiums on their behalf.  

Employers with at least one employee working in the state of Washington should notify their employee(s) who work in Washington regarding the new 2026 rate and coordinate with their payroll vendors to update the new rate to be applied on January 1, 2026. (Employers are not allowed to retroactively withhold premiums from employees.)  

Read more information on the 2026 Paid Family and Medical Leave Updates (washington.gov). 

On October 13, 2025, California enacted SB 590, which allows eligible employees to take paid family leave to care for a “designated person,” which is defined as any individual related by blood or whose association with the employee is equivalent to a family relationship.  

Under existing law, employers with at least one employee in California who earns $300 or more in wages in a 12-month period are subject to the state disability insurance program, which is the umbrella program that includes both disability insurance and paid family leave. The new law would require an individual who requests family temporary disability insurance benefits to care for a designated person to identify the designated person and, under penalty of perjury, attest to how the individual is related by blood to the designated person or how the individual’s association with the designated person is the equivalent of a family relationship. The new law will take effect beginning July 1, 2028.  

Employers with employees in CA should ensure that their PFL policies and communication materials reflect these new changes by the bill’s effective date.  

Read the full bill here: SB 590: PFL for Designated Persons

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