November 4, 2025
In response to the continuing state regulatory activity involving health plans and employer sponsored employee programs, we have attached a summary of these legislative updates.
Feel free to contact your Fedeli Group service team to address your regulatory compliance questions and concerns.
Alaska: Workers’ Compensation
On October 31, 2025, the Alaska Workers’ Compensation Division provided a list of Second Independent Medical Examiners.
California: Notice Requirement
Effective immediately, employer notifications for victims of violence no longer carry the requirement to provide information regarding the right to attend specific judicial proceedings when the employee or the employee’s family member is the crime victim. There is no change to the obligations to notify employees regarding potential state-provided paid leave benefits and bereavement leave.
Colorado: Health Insurance Rates
On October 31, 2025, the Colorado Division of Insurance issued notice that a 2.2% annual medical inflation rate shall apply when calculating premium reductions (Individual and small group) on standardized health plans for 2027.
Connecticut: Workers’ Compensation
On October 27, 2025, the Connecticut Department of Insurance approved the National Council on Compensation Insurance’s recommendation to reduce workers’ compensation insurance costs for most businesses. This includes a 3.8% decrease to voluntary market loss costs and a 0.4% decrease to assigned risk rates.
A review by industry reflects varying impacts. Contracting firms shall experience a 4.9% decrease. Manufacturing businesses will undergo a 5.6% reduction to the voluntary market. Office and clerical workers will expect a 1.3% voluntary market increase and a 4.9% raise in assigned risk rates. The rate adjustments will occur on January 1, 2026.
Delaware: Workers’ Compensation
On October 20, 2025, the Delaware Department of Insurance declared new minimum standards for insurance carrier payroll audit procedures under workers’ compensation policies. The insurance carrier is to:
Delaware: Paid Leave Program
On October 23, 2025, the Delaware Department of Labor’s Division of Paid Leave declared a waiver of penalties and interest for all late quarterly submissions during the first year of the program. The waiver was permitted to assist businesses and third-party administrators in administering the new program. All Delaware employers enrolled in the Delaware Paid Leave program are required to submit quarterly Hours & Wage reports and contributions within a six-day submission period.
Delaware: Workers’ Compensation
On October 23, 2025, the Delaware Department of Insurance shared that beginning on December 1, 2025, the voluntary market rates for workers’ compensation insurance will experience an average decrease of 11.6% while the residual market should experience a decrease of 9.08%.
Delaware: Protected Class
On October 31, 2025, the Delaware Department of Insurance informed insurers that “military status” is a protected class under DE H.B. 55.
Idaho: Medicare Marketing
On October 22, 2025, the Idaho Department of Insurance (IDOI) informed insurance carriers and producers, with an emphasis on providers of Medicare Advantage plans, that attempts to restrict access to services have been discovered. The discovered incidents varied from the removal of website enrollment applications, ending or changing producer compensation, and discouraging the sale of these products. Per Idaho Code § 41-1321, the IDOI found that these actions prohibited competition and/or resulted in unfair or deceptive acts in the business of insurance. The IDOI concluded that under Idaho Code § 41-1321 these acts are unfair trade practices.
The IDOI held that to ensure fair competition, carriers must:
Kansas: Health Insurance Market Overview
On October 30, 2025, the Kansas Department of Insurance issued the 2026 Kansas Health Insurance Market Overview: KID-Issue-Brief.pdf
Louisiana: Fraud Reporting
Effective October 20, 2025, the Louisiana Department of Insurance requires insurers and health maintenance organizations (HMOs) to provide more detailed anti-fraud operations information. Specifically, the information shall include the number of:
Insurers are also required to provide reasonable estimates of dollar loss amounts and dollar recoveries due to fraud. This information shall be compiled by type of fraud alleged.
Insurers are to file this information electronically no later than April 1st of each year by using the department’s Industry Access Portal.
Maine: Paid Family and Medical Leave
On October 21, 2025, Maine’s Paid Family and Medical Leave (PFML) program updated the employees Frequently Asked Questions (FAQ) for employees in the following manner:
Michigan: Grants
On October 28, 2025, the Michigan Occupational Safety and Health Administration (MIOSHA) declared that employers with 250 or less employees can apply for a grant of up to $5,000 which is to be allocated for purchasing equipment and associated equipment training costs whose use will generate improved safety and healthy work environments.
Grant information is detailed here: LEO – Grant Program
Michigan: COVID Vaccines
On October 30, 2025, the Michigan Department of Health and Human Services (MDHHS), Michigan Department of Licensing and Regulatory Affairs (LARA) and the Michigan Department of Insurance and Financial Services (DIFS) agencies issued notices advising that COVID-19 vaccines shall continue to be available at no cost. MDHHS and DIFS are coordinating efforts for state-regulated health plans, including Medicaid, shall continue to provide vaccine coverage.
Minnesota: Paid Family and Medical Leave
Effective December 1, 2025, the following Minnesota Paid Family and Medical Leave (PFML) notices shall implement the following requirements:
Minnesota: City of St. Paul
Effective November 16, 2025, an amendment to the St. Paul, Minnesota, Earned Sick and Safe Time Ordinance was completed to align with the state’s Earned Sick and Safe Time law. The amendment addresses the following:
Missouri: Health Insurance Rates
On October 31, 2025, the Missouri Department of Commerce and Insurance (DCI) released the 2026 individual and small group market Missouri health insurance rates. The individual market will increase by an average of 15.6% and the small group market will increase by an average increase of 13.6%. Specific carrier rate increases can be found here: Public posting – Final 2026 Rates.xlsx
New Jersey: Employer Reporting
Effective October 20, 2025, New Jersey shall require employers or contractors hired by a public body to provided certified payroll records to both the Department of Labor and Workforce Development and to the public entity that hired the employer or contractor.
Public body work includes construction, demolition, repair, and maintenance contracts with government entities, along with public financial assistance projects funded through loans, grants, tax exemptions or other incentives.
New Jersey: Employee Meetings
Effective December 2, 2025, New Jersey restrictions against captive audience meetings
shall also include mandatory employer meetings to address its position on employee decisions to join or support a labor organization.
New York: Paid Family Leave
Effective January 1, 2026, employees on Paid Family Leave will receive 67% of their average weekly wage, up to a maximum of 67% of the New York State Average Weekly Wage (NYSAWW), or $1,833.63 for 2026. This results in a maximum weekly benefit of $1,228.53 and a total potential maximum benefit of $14,742.36.
Beginning on the 1st of each year, employees will contribute 0.432% of their gross wages per pay period to pay for Paid Family Leave. The maximum annual contribution is $411.91 which is 0.432% of the NYSAWW. Employees who earn less than the NYSAWW will have contributions below the annual cap of $411.91. NY PFL Update information can be found here: NYS Workers’ Compensation Board Chair Freida D. Foster Announces NYS Paid Family Leave Updates for 2026
North Carolina: Health Insurance Rates
On October 29, 2025, the North Carolina Department of Insurance finalized the 2026 Affordable Care Act insurance rates. The average 2026 rate increased by approximately 28.6%. Individual insurance policies increased between 16.88% to 36.4%. Small group policies increased between 12.66% to 17.5%. Specific carrier rate adjustments can be seen here: open
Oklahoma: Medical Contracting
On October 31, 2025, the Oklahoma Insurance Department advised health insurers of their requirement to credit patients’ deductibles should an agreement occur for a better price than what the insurance plan offers. This applies to medically necessary care covered by the plan. Patients are to submit electronic documentation detailing that the negotiated price is lower than the insurer’s covered payment amount.
Oregon: Workers’ Compensation
On October 20, 2025, the Oregon Workers’ Compensation Division (OWCD) declared that the workers’ compensation premium assessment rate shall remain at 9.8% for 2026. The assessment provides operation funding for multiple state agencies administering claims for workplace safety and workers’ compensation.
Self-insured employers and public-sector groups will pay 9.9%, and private-sector self-insured groups will pay 10.3%.
Texas: Workers’ Compensation
On October 29, 2025, the Texas Department of Insurance issued the 2026 Insurance Carrier Assessment Plan. The plan ensures insurance carriers and health care providers compliance with Texas Labor Code §402.075 and 28 Texas Administrative Code §180.19 through Performance Based Oversight (PBO). The PBO review is utilized for setting performance expectations, reward excellence, and encourage consistent improvement.
Wisconsin: Workers’ Compensation
On October 21, 2025, the Wisconsin Department of Workforce Development (DWD) announced upgrades to the online system that insurance carriers, employers and claim adjusters use for submitting required work-related injury data. The portal modifications address:
DISCLAIMER
The information provided by The Fedeli Group’s Compliance Alert is not intended to be, nor should it be, interpreted as conferring legal advice to the reader of the Compliance Alert. The Fedeli Group Compliance Alerts are designed specifically and solely for informational purposes. Should the reader have any legal questions or concerns after reading this Compliance Alert, it is recommended that the reader seek counsel for a formal opinion.
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