Understanding the New Healthcare Landscape: Key Insurance Changes Taking Effect June-July 2025

Changing Health Insurance Rules for 2025

Big changes are coming to health insurance in mid-2025, and understanding them now will help avoid surprises later. The IRS has announced new contribution limits for Health Savings Accounts (HSA) and High Deductible Health Plans (HDHP). These increases affect both individuals and families. Prescription drug costs are also in the spotlight, following a recent executive order to improve pharmacy benefit transparency and reduce prices. Independence Blue Cross will roll out important formulary updates, switching to more affordable biosimilars and revising coverage rules.

Employers, plan administrators, and individuals all have a stake in these updates. Early preparation can help organizations adjust communications, benefits, and payroll systems smoothly. By staying ahead of these shifts, everyone benefits from a more transparent, cost-efficient health insurance landscape.

Transitioning forward, understanding how contribution limits will affect accounts and budgets is crucial.

2026 HSA and HDHP Contribution Limits: What’s Changing

Higher Savings and Plan Limits for 2026

The IRS has announced new benchmarks for 2026 that affect Health Savings Accounts (HSAs), High Deductible Health Plans (HDHPs), and Excepted Benefit Health Reimbursement Arrangements (EBHRAs). For individuals with HSA plans, the annual contribution cap climbs to $4,300. Families will be able to contribute up to $8,750. These higher amounts help account for rising healthcare costs and inflation, giving participants an opportunity to set aside more for medical expenses each year.

Alongside these HSA changes, minimum deductibles for HDHPs are increasing as well. Out-of-pocket maximums will also be revised upward, meaning those with high-deductible plans should check how their budgets might be affected. The goal is to keep these limits in line with healthcare cost trends, helping plans stay compliant while also managing affordability.

What the New EBHRA Limit Means

Another important update: excepted benefit HRA contribution limits rise to $2,200. EBHRAs are used to reimburse medical expenses not covered by a major medical plan. While they’re exempt from some ACA requirements, they still need to follow nondiscrimination rules. This boost gives employers more flexibility in their benefit offerings and may help employees manage out-of-pocket costs better.

Employers and administrators should review their plan documents and update payroll systems to reflect these changes before the new year rolls in. Staying proactive with these adjustments is key to avoiding compliance problems.

With these financial updates in place, it’s also smart to look at other reforms taking shape across the health benefits space.

Executive Order on Drug Pricing: Reshaping the PBM Landscape

Big Moves Toward Drug Price Transparency

On April 15, 2025, a sweeping executive order was signed by former President Donald Trump to lower prescription drug costs. The main focus? Pharmacy Benefit Manager (PBM) practices. PBMs play a huge role in setting what people pay for their medications, but until now, their rebate structures and compensation details have mostly stayed under wraps.

The new order directs federal agencies to dig deep into how PBMs operate. A special spotlight is on rebate arrangements—those behind-the-scenes discounts and payments between PBMs, drug makers, and insurers. The goal is for these deals to be more transparent, shining a light on potential conflicts of interest and unfair pricing practices. This could mean direct discounts for patients instead of savings being funneled through layers of middlemen.

What’s Expected from Employers

The Department of Labor is preparing to propose ERISA rules. These new rules will require employers offering group health plans to disclose compensation arrangements with PBMs. Employers need to be ready for stricter reporting and to review their contracts with these administrators.

This push for transparency will help companies compare options and negotiate better terms. More visibility also means plan sponsors could better meet their fiduciary duties and protect their employees from hidden costs.

As other changes come into effect soon, employers and HR teams should start reviewing their current pharmacy benefits, keep an eye on agency updates, and line up resources so they’re ready for what’s next.

Independence Blue Cross Formulary Updates: July 2025 Implementation

Key Adjustments to Prescription Coverage

Big changes are coming to Independence Blue Cross (IBX) prescription coverage effective July 1, 2025. The Premium Formulary will now feature biosimilar substitutions, meaning drugs like Wezlana will take the place of more expensive options such as Stelara. Certain medications, including Sprycel and Pitavastatin, will be excluded. IBX is adding new protocols, like step therapy and tighter quantity limits for drugs such as Motegrity and Eliquis. These steps help balance affordability and therapeutic value for plan members while keeping overall plan costs in check.

Select and Value Formularies: Tiers and Prior Authorization

Changes are also being rolled out to the Select and Value Formularies. You’ll notice some drugs added, while others are removed, shifting tier rankings. These updates may affect copays and require members to adjust to new clinical guidelines or authorization steps before receiving certain prescriptions. Upfront notification will go out, so providers and members can make informed choices.

Helping Members Navigate Changes

It’s crucial for employers to keep everyone in the know. Pre-implementation communication is key—inform your teams, update benefit documents, and make sure members can access online formulary tools. Clear guidance makes it easier for employees to manage medication switches or address coverage questions with less stress, ensuring a smooth transition.

With these formulary changes underway, it’s important to also be aware of new updates in payment processes.

Critical Administrative Updates: ACH Authorization Changes

New Payment Procedures for Premiums

Starting July 2025, Independence Blue Cross (IBX) will implement new company codes for ACH (Automated Clearing House) payments. This update is part of IBX’s effort to modernize its payment platform. If your organization pays IBX premiums by ACH, you’ll need to authorize these new codes with your bank to prevent any payment disruptions.

Why Timely Action Matters

Without prompt updates to your bank’s ACH authorization list, premium payments could be delayed or even rejected. This puts both active coverage and company compliance at risk. For groups whose banks require manual approval of new ACH codes, this step is especially critical.

What to Do Next

Plan administrators should act as soon as notification is received.

Start communicating with your payroll or finance team now to keep payment processing on track. Staying proactive with administrative details not only prevents headaches but keeps your organization financially secure as you navigate other coming insurance changes.

Compliance Alert: PCORI Fee Deadlines for Self-Insured Plans

What Is the PCORI Fee?

The Patient-Centered Outcomes Research Institute (PCORI) fee is an annual payment required from employers who sponsor self-insured health plans, including level-funded plans and Health Reimbursement Arrangements (HRAs). Established under the Affordable Care Act, this fee helps fund national health research. If your plan year ends between October 1, 2012, and September 30, 2029, the fee is mandatory.

Key Dates and Filing Requirements

The critical date to remember is July 31. By this time each year, employers must file IRS Form 720 and pay the required PCORI fee for each covered life on the plan. Missing this deadline could result in penalties, so it’s important to act early.

Calculating and Documenting Your Payment

To calculate the fee, use one of the IRS-approved methods to count the average number of lives covered during the plan year. Collaborate with your benefits administrator or a third-party consultant if needed. Once calculated, keep records of your method and headcounts for audit purposes.

By staying organized and meeting filing deadlines, employers can avoid penalties and ensure smooth plan operations as other health insurance changes unfold.

Action Steps: Preparing Your Organization for These Changes

Key Milestones and Timelines

To keep your organization on track, map out all upcoming deadlines. By July 1, 2025, update ACH bank authorizations with IBX’s new company codes to ensure smooth premium payments. Plan for July 31, when IRS Form 720 and PCORI fee payments are due for self-insured plans. Make sure all 2026 HSA, HDHP, and EBHRA contribution limits are reflected in your open enrollment guides—these take effect with the new plan year.

Communication Strategies

Clear, early communication is crucial. Notify employees and plan members about changes to HSA limits, drug formularies, and any new prior authorization rules. Use multiple channels—like email blasts, virtual meetings, and FAQs. Consider Q&A sessions so employees feel heard and supported during transitions.

Staying Informed

Assign a compliance lead to track IRS, Department of Labor, and IBX updates. Partner with your benefits consultant to review plan documents frequently. Bookmark trusted regulatory sites for real-time changes and share updates with your HR team and members.

Staying proactive and agile makes all the difference when navigating new regulations and health plan requirements.