State Updates

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 may request a smaller supply and a healthcare provider is permitted to prescribe a smaller supply based on medical appropriateness and clinical utility.

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 176.

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 provider must accept the payment as payment in full and not bill the insurer or the enrollee any balance. The enrollee must submit to the insurer documentation, including details of the service, the negotiated fee from the healthcare provider, and the final bill showing the amount paid.  

Insurers are responsible for bringing applicable fully insured plans into compliance. Employer plan sponsors should be aware of the changes. Considering the nature of the new law, employers may consider working with the insurer to educate participants of their new right under the plan.  

Read the full legislation: SB 515.

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 is any entity that engages in the practice of assembling, collecting, analyzing, using, evaluating, storing, or transmitting protected health information. The new law takes effect on September 1, 2025. The storage requirements outlined in the new law apply to the storage of an electronic health record on or after January 1, 2026, regardless of the date on which the electronic health record was prepared.  

The definition of “covered entity” appears to be broad enough to include any entity (whether inside or outside Texas) that maintains PHI for Texas residents. Employers with plans that cover Texas residents should consult with their attorneys to determine if they fit into this definition and, if so, to ensure they are following this law. Employers with fully insured plans should also consult with their carriers to determine whether they are complying with this law.

Read the full legislation: SB 1188.

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 Carolina that does not comply with the standards set by the federal rule that is presently in place.

The bulletin was released in light of an August 7, 2025, statement from the DOL, HHS, and the U.S. Treasury, which announced their intention to start the rulemaking process to revise the current definition of STLDs and indicated that they would not prioritize enforcement actions under the current rule.

Read the full release: Bulletin Number 25-B-11.

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 contribution before the end of the calendar year, the employee shall not be liable for any additional contributions that year.

NY PFL applies to all private employers, including out-of-state employers, with at least one employee working in New York. The state’s PFL program 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. The PFL premium rate, like the benefit amount, is set as a percentage of an employee's covered wages; therefore, so the premium paid by an employee depends on how much the employee earns. NY PFL premiums can be funded through post-tax employee payroll deductions or can be paid directly by the employer at the employer’s discretion.

New York employers should be aware of this and must collect employee contributions that are consistent with this decision.

Read the update on rate changes: NY DFS: 2026 PFL Rates. 

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 guidelines outlined in 26 USC 152: Dependent defined and resides in the policy’s service area. Interestingly, the bill does not include the parent or stepparent of the insured’s spouse as an eligible dependent.

The bill only applies to policies written in Illinois, so employers with policies issued outside of Illinois do not have to comply, even if the policy covers Illinois residents. Self-insured plans are also exempt from the legislation.

Employers who sponsor fully insured health plans in Illinois should work closely with their insurance carrier to make the appropriate policy changes as needed.

On July 30, 2025, the state of Delaware enacted HB 128, amending the Healthy Delaware Families Act, which governs the state’s Paid Family and Medical Leave Insurance Program. The amendment prohibits employers from requiring employees to use accrued paid time off before accessing PFMLA. In addition, employees applying for paid family leave benefits must disclose any outstanding child support obligations to the Delaware Department of Labor. Employers must also coordinate other available benefits with PFMLA payments according to the terms of the applicable policies. Employers with approved private plans are also no longer required to submit claim documentation to the state unless the claim is subject to an appeal, complaint, audit, or specific inquiry.

These amendments take effect immediately, and employers preparing for the rollout of the Delaware Paid Family and Medical Leave Insurance Program in January 2026 should update their leave policies and procedures as necessary to reflect the new changes.

Read more on Delaware’s HB 128: Family and Medical Leave Insurance Program Amendments.

On June 25, 2025, Gov. Green signed SB 1281 into law. The law extends the temporary requirement for reimbursement parity in telehealth services and permits reimbursable mental health services to be provided via audio-only.

Specifically, reimbursement for telehealth services provided via audio and video must be equivalent to reimbursement for the same services provided via in-person contact. With respect to audio-only mental health services, the law requires reimbursement equivalent to 80% of the reimbursement for the same services provided via in-person contact. However, for audio-only mental health services, the healthcare provider must first conduct an in-person visit or an audio and video telehealth visit six months prior to the initial audio-only visit or twelve months prior to any subsequent audio-only visit.

The requirements apply to policies issued or renewed in Hawaii and sunset on December 31, 2027. Employers sponsoring health plans in Hawaii should be aware of this development and contact their carrier for further information.

Read more on SB 1281.