News Archive

13 pages. "Today's employers are confronting a health care landscape increasingly defined by 2 closely related trends: [1] The overall health status of the U.S. population is declining, and [2] health care costs are rising.... Even as the workforce becomes younger, members are growing sicker faster, and overall member spend continues to rise.... By detailing the health and cost trends of members by both age and gender, this white paper can help employers prioritize member engagement efforts. "  MORE >>

"The Federal Departments released proposed Transparency in Coverage (TiC) regulations to improve the public disclosure of prices for medical items and services. [This article describes] [1] The issues that make pricing data challenging to download, understand or consume. [2] Four new files to provide additional pricing context: Change Log, Utilization, Taxonomy and Text. [3] Changes to the INN Rate and OON Allowed Amount Files, which are intended to reduce the size of the Files and increase the amount of usable pricing data."  MORE >>

"[T]he proposed regulation is much broader than the corresponding rule for pension and retirement plans, not only in terms of the type of compensation and fees that are subject to disclosure but also regarding [1] the extent of the written disclosure, [2] the timing and frequency of disclosure, [3] the requirement to generally disclose using monetary amounts (versus formulas or percentages), and [4] the provision of specific rights to plan fiduciaries with respect to the disclosures (e.g., audit rights)."  MORE >>

"Healthcare affordability for employers in 2026 requires a three-pronged approach: [1] Active management of high-cost pharmacy drivers like GLP-1s. [2] Optimized Health Savings Account (HSA) plan designs. [3] Integration of Artificial Intelligence (AI) to streamline benefits education."  MORE >>

"The cost for a patient with one chronic condition was nearly double that for a patient with no chronic conditions ... The average allowed amount for a patient with no chronic conditions was $1,590, while the average allowed amount for a patient with one chronic condition was nearly double ($3,039). Of 44 common chronic conditions studied, hyperlipidemia, or high cholesterol, was the most common, with a crude prevalence of 21.2 percent."  MORE >>

"Rising healthcare costs and unpredictable renewals are pushing more employers to explore self-funded insurance as a smarter alternative to fully insured plans.... A typical self-funded plan includes: [1] Third Party Administrator (TPA) ... [2] Stop-Loss Insurance ... [3] Pharmacy Benefit Manager (PBM) ... [4] Targeted support for areas like diabetes, MSK, or mental health ... [5] Alternative pricing strategies including reference-based pricing."  MORE >>

"The Proposed Rule attempts to provide ... transparency by: [1] Requiring PBMs to provide written disclosures of the PBM's direct and indirect compensation ... reasonably in advance of entering into or renewing a service arrangement ... [2] Establishing audit provisions designed to ensure that plan fiduciaries can verify the accuracy of the disclosures; and [2] Providing relief for plan fiduciaries if the PBM fails to meet its disclosure obligations.... [T]he Proposed Rule would require PBMs to disclose compensation as a monetary amount (even if estimated), rather than providing formulas, which are notoriously difficult for fiduciaries to assess when evaluating reasonableness."  MORE >>

"The minimum penalty for each violation of a particular HIPAA requirement or prohibition increases to $145 (up from $141) for a covered entity or business associate that did not know -- and could not have known by exercising reasonable diligence -- about the violation. For violations due to reasonable cause and not willful neglect, the minimum penalty increases to $1,461 (up from $1,424).... The calendar-year penalty cap increases to $2,190,294 (up from $2,134,831) for all violations of an identical HIPAA provision."  MORE >>

"44.9% of all health care payments across all lines of business were tied to APMs that hold providers accountable for quality and cost of care (HCPLAN Categories 3-4) in calendar year (CY) 2024 compared to 45.2% in CY 2023. 28.7% of health care payments across all lines of business were tied to APMs with downside risk (HCPLAN Categories 3B-4) in CY 2024 compared to 28.5% in CY 2023."  MORE >>

"The Committee for a Responsible Federal Budget just dropped a detailed analysis on implementing RBP for the Federal Employee Health Benefits program. Buried in there is a roadmap for what ANY employer can expect when they stop letting hospitals yank them around with astronomical chargemaster pricing and just as phony carrier 'discounts.' The government's proposed pricing target amount of 200% of Medicare will deliver about 12% total savings. Go to 150% of Medicare? You're looking at 22% savings. Even at 250%, you still get 5-6% back."  MORE >>

"The premium adjustment percentage for the 2027 benefit year is 1.8916224814 ($8,919/$4,715), which represents an increase in PHI premiums of approximately 89.2 percent over the period from 2013 to 2026....

'[T]he 2027 maximum annual limitation on cost sharing is $12,000 for self-only coverage and $24,000 for other than self-only coverage. This represents an approximately 13.2 percent increase from the 2026 parameters of $10,600 for self-only coverage and $21,200 for other than self-only coverage....

'[T]he 2027 required contribution percentage under section 5000A of the Code [is] ... 8.50 percent ... an increase of approximately 0.45 percentage points from the 2026 value."  MORE >>

"The complaints generally allege that the employers offering these programs could and should have negotiated lower premiums. According to the plaintiffs, the higher premiums may be the result of potentially excessive broker commissions, and excessive compensation to the consultants that administer them. The complaints speculate that employers offer these voluntary benefit programs without first engaging in a request for proposal process."  MORE >>

"EBRI research has examined the premium implications of expanding pre-deductible coverage in high-deductible health plans (HDHPs) paired with HSAs ... This analysis of IRS Notice 2019-45 found little to no impact on premiums. More recent EBRI research extending pre-deductible coverage to a much broader set of 116 drug classes similarly found that estimated premium increases remained modest."  MORE >>

"How could an eye doctor be in-network and out-of-network at the same time? ... UnitedHealthcare representatives explained that the eye clinic was in-network under her vision plan, so her policy would cover the clinic's services related to glasses or contact lenses. But they said the clinic was not in-network for her medical insurance plan, and glaucoma treatment is considered a medical issue.... [A] UnitedHealthcare spokesperson ... said such arrangements are common, including with non-Medicare insurance provided by employers or purchased by individuals."  MORE >>

"The proposed Great Healthcare Plan is aimed at reducing prescription drug costs, lowering insurance premiums, and expanding transparency in the healthcare system. While the proposal requires congressional action and may evolve significantly, it highlights policy priorities that could shape future legislation and regulatory initiatives impacting employer-sponsored health and welfare plans."  MORE >>

"Selecting a carrier with strong financial backing may provide greater possibility that they can handle large claims, even in catastrophic situations.... The best carriers go beyond basic coverage, offering predictive analytics, specialty drug management, and alternative care programs.... Partnering with a carrier that offers pricing stability and customized solutions can help you adapt over time, and may help reduce volatility in your benefits strategy."  MORE >>

"Per person spending among people with employer-sponsored insurance grew nearly 19% from 2018 to 2022, a combination of 14% price growth and 4% utilization growth.... Spending on urgent care grew at a substantially faster rate (more than 50%) from 2018 to 2022, and, unlike most health care categories, was driven primarily by a substantial increase in utilization."  MORE >>

"The average value of APTC subsidies was originally designed to be worth 5% less to workers than the ESI tax exemption, in order to maintain incentives for employers to provide health-care benefits. But the expanded subsidies average 65% more than the value of the ESI tax exemption. If all employers stopped offering health-care coverage to workers, to allow them to claim these expanded subsidies, it would increase the cost to the federal budget by $250 billion per year."  MORE >>

"Congress has been ... reducing federal health spending through cuts in Medicaid and the ACA tax credits, shifting cost burdens to states and to consumers.... [R]educing health care costs has become a Darwinian game; everyone wants to reduce health care costs and spending -- their own, often at the expense of someone else. It's like a Venn diagram with spending problems that only somewhat overlap and more often conflict."  MORE >>

15 pages. "Unlocking the potential to grow sustainably is a key challenge for many health insurers, especially in the face of high medical inflation driven by medical advancements, heightened geoeconomic uncertainties and ageing societies.... This article explores the use of a capital optimization solutions framework that aims to maximize strategic value from available capital resources while ensuring that firms' regulatory requirements and other business constraints continue to be met."  MORE >>

"[HHS] updated guidelines, effective Jan. 13, 2026, that set the 2026 federal poverty level (FPL) at $15,960 (up from $15,650 in 2025) for a person working in the mainland US, but $19,950 (up from $19,550 in 2025) for a person working in Alaska and $18,360 (up from $17,990 in 2025) for a person working in Hawaii. Under the [ACA], the FPL can affect employer shared-responsibility (ESR) play-or-pay assessments[.]"  MORE >>

"[N]ew proposed regulations that expand the requirements under the existing transparency regulations relating to machine-readable files. These new proposed regulations, the existing transparency regulations, the hospital price transparency initiative, and the No Surprises Act collectively represent a push and movement by the federal government to empower patients with meaningful price information. Now, states are also taking action."  MORE >>

"Many employers have reached rock bottom. They can't increase deductibles, copays, or out-of-pocket maximums any further without bankrupting their employees or violating the mandates of Obamacare.... There is no more powerful tool than RBP and true Rx change (achieved by ditching the Big-3 PBMs) to combat these intrinsic government-industrial complex healthcare ills. Put simply, with RBP, you tie your increase to the orange trend line instead of the blue one in the graph."  MORE >>

"Retirement and financial wellness are core to total rewards strategies: Nearly all employers (98%) offer a qualified retirement plan; 56% match between 3-4.9%, and nearly 30% match over 5%.... 77% of organizations already have or are planning to implement financial wellness plans.... Nonqualified deferred compensation (NQDC) plans remain vital for executives: 88% of eligible participants are CEOs, 70% VPs, and 38% directors. Rising health plan costs are shifting approaches: One-third of employers saw 4-8% increases, with another third reporting higher costs. Cost-sharing is shifting to employees, and Health Savings Accounts (HSA) continue to rise."  MORE >>

"Those responsible for calculating QPAs on behalf of group health plans and insurers will need to take note of this guidance as they implement these complex rules for 2026. The table of cumulative percentages provided in [Notice 2025-65] may help simplify the calculations"  MORE >>