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Analysis Suggests Anthem Deal Could Raise Health Costs

"Anthem has said the added heft will work for employers, not against them. A bigger Anthem, it emphasizes, could drive better deals from doctors and hospitals and pass savings onto these customers. In addition, Anthem has argued that there still will be plenty of competition: large employers pit smaller, local insurers' bids against those of large national carriers in regional markets.... But an Aon Hewitt analysis of benefits data for Reuters found that a majority of large employers buy worker health benefits from just one or two insurers."  MORE >>

Retirement Plans Tap Multiple Managers After PIMCO Drama

"More than 27,000 of the largest corporate 401(k) plans in the country had over $80 billion in the [PIMCO] Total Return Fund at the end of 2013 ... The roster included Wal-Mart's $20.6 billion plan, the largest in the country by participants, as well as Raytheon's and Verizon's.... There is no data on how many plans have replaced PIMCO Total Return for multiple managers or team managed funds, but advisers who consult retirement plans with tens of billions of dollars in assets told Reuters they are doing so."  MORE >>

As Obamacare Tech Woes Mounted, Contractor Payments Soared

"As U.S. officials warned that the technology behind Obamacare might not be ready to launch on October 1, the administration was pouring tens of millions of dollars more than it had planned into the federal website meant to enroll Americans in the biggest new social program since the 1960s. A Reuters review of government documents shows that the contract to build the federal Healthcare.gov online insurance website ... tripled in potential total value to nearly $292 million as new money was assigned to the work beginning in April this year."  MORE >>

More Health Plan Participants Checking Out Prices (PDF)

The latest Thomson Reuters-NPR Health Poll found that a 16 percent of Americans indicated they sought pricing information before receiving healthcare services, and of those who did, 49 percent received this information from insurance companies. This represents a significant shift from when respondents were asked the same questions in 2010, when only 11 percent said they sought such pricing information.

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HHS Vacates Gender Identity Provisions of ACA Section 1557 Nondiscrimination Rules (PDF)

"Employers and their advisors should be aware that HHS will not take action based on the gender identity provisions of the 2024 regulations while the vacatur remains in effect, but the remainder of the 2024 regulations continues to apply, and other federal nondiscrimination laws -- including Title VII of the Civil Rights Act, as interpreted by the U.S. Supreme Court -- may independently address gender identity discrimination in certain contexts"  MORE >>

What Expenses Can Be Reimbursed Under a Qualified Educational Assistance Program?

"Education cannot relate to a sport, game, or hobby, unless it involves the employer's business or is required as part of the student's degree program. Meals, transportation, and lodging cannot be reimbursed. Supplies and equipment (other than textbooks) can only be reimbursed if they cannot be kept after the course is completed."  MORE >>

Agencies Finalize Extensive Modifications to Regs Implementing Surprise Billing IDR (PDF)

"These final rules represent a significant step in the agencies' ongoing efforts to address inefficiencies in the federal IDR process, which has been burdened by high dispute volumes and complex eligibility determinations. Plan sponsors and their advisors should take note of the new communication requirements as these will require coordination with insurers, TPAs, and other service providers. Self-insured health plans should be particularly attentive to the updated batching rules, which differ in important respects from the proposed rules."  MORE >>

Are Employees Who Complete a Tobacco-Cessation Program Midyear Entitled to Retroactive Refund of Premium Surcharges Paid Earlier in the Year?

"Although recent court decisions are mixed, cautious group health plan sponsors should assume that participants who complete a cessation-based reasonable alternative standard (RAS) midyear are entitled to the full value of that year's tobacco-related reward, requiring a retroactive refund or equivalent credit."  MORE >>

District Court Recognizes Private Right of Action to Enforce No Surprises Act IDR Award (PDF)

"This decision adds to a growing split on whether providers may enforce IDR awards through private litigation. While the Fifth Circuit has held that no such right exists, this court and certain other federal trial courts have concluded otherwise, meaning that plans and insurers operating outside the Fifth Circuit may face greater exposure to enforcement lawsuits when they fail to pay IDR awards within the required 30-day window." [PHI Health, LLC v. Optimum Choice, Inc., No. 25-2320 (D. Md. Mar. 27, 2026)]  MORE >>

IRS Issues Guidance on 401(k) Plan Long-Term Care Distributions (PDF)

"Qualified long-term care distributions, established by the SECURE 2.0 Act, are plan distributions made after December 29, 2025, that satisfy specified criteria ... [IRS Notice 2026-33] explains that qualified long-term care distributions are considered to [1] satisfy the Code Section 401(k)(2)(B) distribution rules (and similar rules under Code Sections 403 and 457), [2] are not subject to the additional 10% tax on early distributions under Code Section 72(t), and [3] are not eligible rollover distributions."  MORE >>

Do We Need to File Form 5500 for Our Company's Cafeteria Plan?

"Although Code Section 6039D requires employers to file annual returns for cafeteria plans, the IRS suspended that requirement in 2002. Nevertheless, the DOL's Form 5500 requirement continues to apply to many employee welfare benefit plans that are governed by ERISA. A cafeteria plan is merely a funding vehicle for its component benefit plans and is not itself an ERISA employee welfare benefit plan, but component plans that are ERISA plans (e.g., medical plans or health FSAs) must file Form 5500s unless exceptions apply."  MORE >>

District Court Upholds IRS Authority to Certify Employer Shared Responsibility Penalties (PDF)

"The court reasoned that administration of the Code rests with the IRS absent an express delegation of authority to another agency, and that no such express delegation existed here.... Concluding that Letter 226-J satisfied the certification requirement, the court ruled without a trial in favor of the government and denied the employer's refund claim.... This decision creates a split at the trial court level on the question of whether the IRS or HHS has the authority to issue the certification required before an employer shared responsibility penalty can be assessed." [Supreme Linen Services, Inc., v. U.S., No. 25-20723 (S.D. Fla. Feb. 25, 2026; on appeal to 11th Cir. No. 26-11299)]  MORE >>

Can Our Company Condition a Job Offer on the Applicant's Agreement Not to Enroll a Child with a Known Disability in Our Health Plan?

"The action you describe likely violates the ADA's association provision. You are probably familiar with the ADA provisions that prohibit an employer from discriminating against a qualified individual with a disability ... This course of action also raises concerns under other laws, including HIPAA's nondiscrimination provisions, which prohibit group health plans and insurers from discriminating with regard to eligibility or premium contributions based on health factors."  MORE >>

Sixth Circuit: ERISA Preempts Application of State Pharmacy Network Laws to Self-Insured Plans (PDF)

"This decision reinforces the broad scope of ERISA preemption for self-insured health plans. While the Supreme Court's Rutledge decision narrowed preemption in some ways, this ruling illustrates that state laws directly regulating the design and structure of a self-insured plan's benefits, such as AWP laws, are still likely to be preempted." [McKee Foods Corporation v. BFP Inc., No. 25-5416 (6th Cir. Apr. 7, 2026)]  MORE >>

DOL Advisory Opinion Concludes That Farm Bureau Federation Health Plan Would Be a Single ERISA Plan and a MEWA (PDF)

"Status as a single ERISA plan is significant for several reasons. If a MEWA is not an ERISA plan, each participating employer is treated as maintaining a separate plan potentially subject to ERISA compliance obligations, such as furnishing summary plan descriptions and filing Form 5500s, rather than those requirements applying at the MEWA level. Also, due to ERISA preemption, a MEWA that is an ERISA plan is somewhat less encumbered by state regulation than one that is not an ERISA plan." [Advisory Opinion 2026-01A]  MORE >>

Should We Provide a COBRA Notice of Unavailability to an Individual Who Is Not Covered Under Our Plan?

"[E]ven though your employee's son is not a COBRA qualified beneficiary (because he was not covered by the plan when he lost eligibility), he is still an 'other individual' to whom you must provide a notice of unavailability. The notice must be written in a manner calculated to be understood by the average plan participant and must explain why the individual is not entitled to COBRA (or an extension of COBRA)."  MORE >>

What Is the Status of the ACA's Insured Health Plan Nondiscrimination Requirements?

"Although insured group health plans initially were required to comply with the ACA nondiscrimination rules for plan years beginning on or after September 23, 2010, the IRS announced in Notice 2011-1 that compliance is not required until the agencies issue regulations or other guidance regarding how the rules apply to insured plans. To date, the agencies have not issued such regulations or guidance, so sanctions for failure to comply do not yet apply for insured plans."  MORE >>

First Circuit Rejects Another ACA Section 1557 Claim Challenging Weight-Loss Drug Exclusion (PDF)

"This decision ... may offer some reassurance to plan sponsors that have similar plan exclusions, as it holds that a broad exclusion for weight-loss drugs does not, by itself, state a claim for disability discrimination under ACA Section 1557. However, the legal landscape is still evolving, and other courts could reach different conclusions." [Holland v. Elevance Health, Inc., No. 25-1359 (1st Cir. Mar. 27, 2026)]  MORE >>

Do HIPAA Notices of Privacy Practices Need to Be Updated to Address Part 2 Records?

"If your plan (or any of its business associates) creates, receives, maintains, or transmits information that qualifies as Part 2-protected substance use disorder (SUD) patient records, then your plan should treat the Part 2-related NPP revisions as mandatory content requirements that are enforceable as of February 16, 2026."  MORE >>

$3 Million Settlement Approved in ACA Section 1557 Dispute Over Hearing Aid Exclusion (PDF)

" This settlement highlights the ongoing legal risks for plan sponsors and insurers that maintain broad exclusions for items or services closely associated with a disability. Although the settlement is not an admission of wrongdoing, it underscores that even seemingly neutral plan terms can be challenged as discriminatory under ACA Section 1557. Plan sponsors should review their plan documents for exclusions that may have a disproportionate impact on individuals with disabilities and consider the potential for proxy discrimination claims"  MORE >>