April 2025 HR Update

Report Finds 1 in 4 Workers Unaware of Mental Health Benefits

A survey conducted in January 2025 by the National Alliance on Mental Illness (NAMI) found that one in four workers is unaware whether their employers offer mental health benefits, employee assistance programs, flexible work arrangements or sick days for mental health. Only half understand how to access these benefits through their employer-sponsored health insurance.

The second annual survey, conducted with Ipsos, polled over 2,000 full-time employees from companies with over 100 workers across multiple industries.

Similar to last year’s findings, NAMI found that only about a fifth of employees have received training on mental health conditions or symptoms, despite more than three-quarters expressing interest in learning about mental health benefits and receiving general education about mental health.

“These results show a high demand for mental health education and resources, with mental health challenges emerging across the workforce.” – Daniel H. Gillison Jr., CEO at NAMI

Although workers have voiced a strong desire for mental health care benefits, HR professionals report that these offerings are often unutilized. A separate One Medical survey found that workers avoid using these benefits for several reasons. Almost half (45%) of employees cited a lack of time, 25% reported feeling embarrassed and 22% mentioned cost concerns.

Furthermore, this report demonstrates that stigma and judgment surrounding mental health issues persist in many workplaces. NAMI data shows that more than half of employees are comfortable discussing their mental health with a close friend or manager. At the same time, only 39% would feel comfortable discussing their mental health with HR.

Employer Takeaway

The NAMI survey highlights the need for employers to improve awareness of available resources. To increase the utilization of mental health benefits, NAMI recommends that employers share benefits information through various channels, offer training, and equip managers to share resources and communication information on benefits multiple times throughout the year.

Selecting Your FMLA Leave Year

Under the federal Family and Medical Leave Act (FMLA), covered employers must allow eligible employees to take 12 weeks of unpaid job-protected leave every 12 months for qualifying family and medical reasons. FMLA regulations allow employers to choose one of four methods for determining the 12 months:

1. The calendar year;
2. Any fixed 12-month leave year;
3. The 12-month period measured forward from the date any employee’s first FMLA leave begins or
4. A “rolling” 12-month period measured backward from the date an employee uses any FMLA leave.

The below explains the different types of FMLA years available to employers, along with the benefits and disadvantages of each.

The FMLA Year

The FMLA requires covered employers to provide eligible employees with up to 12 weeks of unpaid, job-protected time off per 12-month period for reasons related to the health and well-being of the employee or their spouse, child or parent. The FMLA also allows eligible employees to take up to 26 weeks of unpaid, job-protected leave during a single 12-month period for military caregiver leave. Military caregiver leave permits the eligible employee to care for an ill or injured service member who is the employee’s spouse, son, daughter, parent or next of kin.

The FMLA regulations provide that employers may select one of four types of 12-month periods, except for military caregiver leave, as discussed below.

1. Calendar Year – This option is straightforward. It is easy for employers to administer and employees to understand, with employees’ 12-week leave entitlement becoming available on Jan. 1. After the 12 weeks of leave are used up, the employee is not entitled to any more FMLA leave until the following Jan. 1.

Despite its clarity, the calendar-year option is somewhat disfavored by employers because it can allow an employee to take as much as six months of continuous leave, depending on the timing of the employee’s FMLA absence.  This can happen if an employee takes 12 weeks of leave beginning Oct. 1 and then extends the leave for another 12 weeks starting Jan. 1 of the new year. The employee is within their rights to do this under the calendar-year method as long as they continue to experience a qualifying reason for FMLA leave.

Many employers prefer to avoid this kind of extended leave, called stacking, despite the administrative ease offered by the calendar-year choice.

2. Fixed,12-month Year – The second option offered by the regulations is any fixed 12-month leave year, such as:

• A fiscal year;
• A year required by state law or
• A year starting on an employee’s anniversary date.

Like the calendar-year option, this method is easy to administer and understand. It also allows employees to stack their leave. Here, the stacking would span the end and beginning dates of an employee’s FMLA year, which may vary depending on what type of “year” the employer chooses.

3. 12-month Period Measured Forward From Start of Leave

Under this method, an employee’s 12-month period begins on the first day they take FMLA leave. The next 12-month period begins the first time they take FMLA leave after completing their previous 12-month period. This option offers the advantage of aligning with the FMLA year employers must use for military caregiver leave. In that sense, it is easier to administer—at least for employers with employees taking FMLA to care for a service member.

On the other hand, like the first two methods, this method allows for a lengthy leave spanning two 12-month periods. Unlike the first two options, however, the extended leave in this instance could not consist of the full 24 weeks of FMLA leave because, with this “measured-forward” choice, 12 months must pass from the date the employee first takes FMLA (the first day of the first leave year) until the first day of the second leave year.

Nonetheless, an employee could take one or two days of FMLA starting January 1 and not retake leave until, say, a few days into October, when they begin extended leave until the end of December. At that point, the employee could start a new FMLA year with a new 12-week FMLA allotment available if they have a qualifying reason for leave.

4. “Rolling” 12-month Period Measured Backward – The final option employers are permitted to choose for measuring the FMLA year is a “rolling” 12-month period, measured backward from the date an employee uses any FMLA leave. This option is also commonly referred to as the “look-back” method. While complicated to understand and track, this method prevents extended FMLA leaves from being possible under the other alternatives, making it a popular choice among employers.

Under the look-back method, when an employee uses FMLA leave, the employer “looks back” 12 months from the first day of the leave and measures how much FMLA leave the employee has used. The employer subtracts that amount from the employee’s 12-week total annual FMLA allotment, and whatever is left is the employee’s available remaining FMLA entitlement.

The U.S. Department of Labor provides an example to show how this works, featuring a hypothetical employee named Patricia, who wants to take FMLA leave beginning November 1:

When Patricia begins FMLA leave on Nov. 1, her available FMLA leave is 12 workweeks less any FMLA leave she used in the previous 12 months. […] Because Patricia’s FMLA leave will begin Nov. 1, the 12-month look-back period is from Nov. 2 of the prior year through Nov. 1. During the 12-month look-back period, Patricia used four workweeks of leave starting Jan. 1, four workweeks beginning March 1, and three workweeks beginning June 1. Therefore, on Nov. 1, she has one week of FMLA leave available. If Patricia uses that week in November, she can next take FMLA leave beginning Jan. 1 as the days of her previous January leave “roll off” the leave year.

Another way of describing the timeline under the look-back method is that employees regain their FMLA leave one year from when they used it. In the example above, Patricia regains her January 1 leave on January 1 of the following year, her January 2 leave on January 2 of the following year, and so on. The regulations note that employers using the rolling 12-month period may need to calculate whether the employee is entitled to take FMLA leave each time that leave is requested. Employees may fall in and out of FMLA protection based on their usage in the prior 12 months.

Additional Requirements

One Method for All Employees

Employers must generally use the same 12-month FMLA period for all their employees. The only exception is when a multistate employer has eligible employees in a state requiring a specific FMLA leave period method. In that case, the employer may choose the state-required method for those employees and use a different method for employees in other states. The regulations require employers who fail to select one of the four methods discussed above to use the 12 months most beneficial to the employee.

Notice

Employers must inform eligible employees of the 12-month period they have chosen in writing in the required FMLA Rights and Responsibilities Notice.

Changing the Method

Employers may change their method of measuring the 12 months to another permitted alternative. Still, they must give employees at least 60 days’ notice of the change, and the transition must allow employees to retain the full benefit of 12 weeks of leave under whichever method affords the most significant benefit to them.

Employer Takeaway

In choosing an FMLA year, employers must weigh the pros and cons of each permitted option. Employers that value ease of communication and administration should consider whether their goals are met best by the first two options: the calendar year and the alternative fixed calendar year. Employers likely to have employees taking military caregiver leave might consider the period measured from the start of the leave. Finally, employers concerned by the potential of employees taking lengthy, continuous FMLA leave will probably be most satisfied with the fourth option, the rolling 12-month period measured backward.

Regardless of which option they choose, employers should ensure they apply the same method consistently and uniformly to all employees and remember to include their chosen method in the FMLA Rights and Responsibilities Notice. Employers should also be aware that if they fail to establish a method of choice, they must use whichever method is most beneficial to employees.

Trump’s Early Initiatives May Impact Health Plan Compliance In the first months of his second term, President Donald Trump and his administration have issued executive orders (EOs) and policy changes that may have significant implications for employer-sponsored health plans. These initiatives include: An EO prioritizing increased healthcare price transparency and directing federal agencies to implement further and enforce transparency rules; An EO directing policy changes to protect access to in vitro fertilization (IVF) and reduce out-of-pocket and health plan costs for such treatments and A recission of Biden-era guidance related to gender-affirming care for minors by the Department of Health and Human Services (HHS). These actions do not change any existing legal requirements. However, they are important indicators and directives to federal agencies regarding Trump’s health policy priorities. The Trump administration will likely issue proposed rules or take other regulatory action on these topics in the coming months. Already, HHS has issued a proposed rule that, if finalized, would place new restrictions on eligibility and enrollment opportunities in the Affordable Care Act (ACA) Health Insurance Marketplaces. Improve Health Care Price Transparency New transparency requirements for employer-sponsored health plans and insurance issuers seek to improve healthcare quality and lower costs by making more information accessible to plan participants and the public. On Feb. 25, 2025, Trump issued an EO titled “Making America Healthy Again by Empowering Patients With Clear, Accurate, and Actionable Healthcare Pricing Information.” The EO states that progress on healthcare price transparency at the federal level has stalled since the end of Trump’s first term. To ensure that patients have the information they need to make well-informed healthcare decisions, the EO directs federal agencies to take the following actions within 90 days: Require the disclosure of actual prices of items and services, not estimates; Issue updated guidance or proposed regulations ensuring pricing information is standardized and easily comparable and Issue guidance or proposed regulations updating enforcement policies designed to ensure compliance with the transparent reporting of complete, accurate and meaningful data. Although most employers rely on their issuers or third-party administrators to satisfy many transparency requirements, employers should still monitor this topic for additional guidance from federal agencies. In addition to taking regulatory action on these items, federal agencies may issue guidance on advanced explanation of benefits (EOBs), a key transparency requirement that has not taken effect yet. When this requirement takes effect, health plans and issuers must send an EOB to covered individuals explaining the estimated cost of an item or service, including the individual’s estimated cost sharing, before a scheduled service. Expand IVF Access and Reduce Costs On Feb. 18, 2025, Trump signed an EO titled “Expanding Access to In Vitro Fertilization,” which calls for his administration to provide policy recommendations for reducing IVF procedure barriers and “aggressively reducing out-of-pocket and health plan costs for IVF treatment” within 90 days. As background, as many as 1 in 7 couples struggle with infertility and may face significant financial hurdles to accessing IVF. The cost of IVF can range from $12,000 to $25,000 per cycle, and multiple cycles may be needed to get pregnant. IVF is often not fully covered by health insurance. Only one-quarter of employers report coverage of IVF for their employees. A handful of states require health insurance issuers to provide coverage for IVF. Without this coverage, many Americans pay out-of-pocket for IVF treatments. It is unclear how the Trump administration may consider expanding access to IVF and reducing costs, but this may include additional coverage mandates for health insurance. Employers should watch for any developments that would impact their health plan coverage. Limit Gender-affirming Care for Minors On Feb. 20, 2025, HHS immediately rescinded its gender-affirming care guidance from March 2, 2022, and was directed to rescind this guidance by Trump’s EO titled “Protecting Children from Chemical and Surgical Mutilation.” The 2022 guidance stated that transgender medical interventions may improve both physical and mental health outcomes for minors and outlined the application of federal civil rights and patient privacy laws to such medical treatments. For example, Section 1557 of the ACA prohibits discrimination based on race, color, national origin, sex, age or disability in health programs and activities that receive federal funding. The 2022 guidance stated that Section 1557 prohibits discrimination based on gender identity in federally funded healthcare settings. Employer-sponsored health plans are only subject to Section 1557 to the extent they receive federal financial assistance. According to HHS, the 2022 guidance no longer reflects its views, and the rescission is a significant step in aligning civil rights and health information privacy enforcement with the Trump administration’s policies. While this development demonstrates the Trump administration’s position on this topic, it does not affect final rules or court decisions. The latest final rule under Section 1557 provides, among other things, that sex discrimination includes discrimination based on sexual orientation and gender identity, as well as sex stereotypes, sex characteristics, and pregnancy or related conditions. However, a federal district court has issued a nationwide injunction preventing enforcement of the final rule as it relates to gender identity. The Trump administration is expected to issue new guidance and rulemaking regarding Section 1557 in the future, stating that its protections do not extend to gender identity. Restrict Marketplace Eligibility and Enrollment On March 10, 2025, HHS released a proposed rule that would implement new standards for the ACA’s Marketplaces to address improper enrollments and promote stable and affordable health insurance markets. If finalized, the changes could make it more difficult for consumers to enroll in coverage, potentially reducing Marketplace enrollment. Key reforms of the proposed rule include: Ending the availability of the monthly special enrollment period for individuals with household incomes below 150% of the federal poverty level; Shortening the annual open enrollment period for all individual market coverage so it runs from Nov. 1 through Dec. 15 preceding the coverage year (instead of through Jan. 15 of the coverage year); Eliminating Marketplace eligibility for Deferred Action for Childhood Arrivals recipients; Requiring Marketplaces to determine an individual ineligible for the advance premium tax credit (APTC) if they failed to file their federal income tax return and reconcile APTC for one year (instead of two consecutive tax years); Allowing insurers to require payment of past-due premiums before effectuating new coverage; and Requiring consumers automatically renewed in Marketplace coverage with no premium (i.e., consumers eligible for APTC that fully cover their premiums) to pay $5 monthly until they confirm their eligibility information. Although these proposed changes would not affect employers directly, they may make it more difficult for employees to enroll in Marketplace coverage. Employers that offer individual coverage health reimbursement arrangements (ICHRAs) may find this problematic, while employers are subject to the ACA’s employer-shared responsibility. Employer Takeaway Other possible priorities of the Trump administration may include: Expanding the availability of short-term, limited-duration health coverage; Increasing access to association health plans; and Weakening (or rescinding) privacy protections for reproductive health care. Employers should expect new regulatory action over the next several months implementing Trump’s health policy priorities, including those outlined above. They should watch for developments and assess the impact of any new regulatory action on their health plan coverage. Federal agencies will likely enhance health plan price transparency measures in the future, which may require employers to work with third-party vendors regarding plan communications and tool updates.