News Archive

"Assembly Bill A9729, effective as of May 22, 2026. is fundamentally a pharmacy practice and licensure law, not a benefits mandate.... Although it does not directly regulate employer health plans, it substantively affects the pharmacy and PBM environment that plans operate within."  MORE >>

"As many employers are navigating higher 2026 HCSO payments, the increase in expenditure rates offers a timely opportunity for employers to review their HCSO compliance process. Failure to meet all compliance requirements using supportable methodology4 could result in investigation, corrective action, and penalties from the San Francisco Office of Labor Standards Enforcement."  MORE >>

"[TPAs], brokers, and benefits technology vendors are increasingly offering [AI] tools that can generate [SPDs], plan summaries, FAQs, and participant communications almost instantaneously. While these tools promise efficiency and reduced administrative burden, plan sponsors should proceed cautiously. Under ERISA, the plan administrator is responsible for maintaining compliant plan documentation and properly distributing required disclosures, including the obligation to furnish paper copies of plan documents upon a participant’s request."  MORE >>

"GAI holds promise to improve efficiency and professional services in tax practice. However, ethical obligations of competence, diligence, and confidentiality remain unchanged. By implementing robust use-management strategies and maintaining human supervision, tax professionals can harness AI's benefits while safeguarding reliability and public trust. As tax practitioners integrate GAI into their workflows, it is crucial to recognize that technology serves as a powerful tool, not a substitute for professional judgment. AI can streamline routine tasks, enhance research, and provide valuable insights, but final decisions must always rest with qualified professionals who understand the complexities of tax law and ethical standards. Practitioners must remain vigilant in reviewing what is produced by AI, validating its factual assertions and citations, and handling sensitive client data safely and securely in accordance with both federal and state regulations."  MORE >>

"The [final rule] represents the most significant procedural overhaul of the IDR system since its launch in 2022, addressing the core dysfunctions that have plagued the process: an overwhelming volume of disputes, inconsistent eligibility screening, administrative fee structures that incentivized high-volume bulk filings, and a lack of standardized procedures. The rule aims to streamline the review process and enhance its auditability."  MORE >>

"A well-managed audit ensures that only eligible dependents remain on the plan, helping reduce unnecessary plan and claims expenses and promoting fair distribution of benefits.... [D]ependent eligibility audits are a practical way for employers to strengthen plan integrity, manage costs, and support responsible benefits administration."  MORE >>

"In most cases, employees at age 65 have the option to remain in active coverage, enroll in Medicare, or both. Most age 65+ retirees should enroll in Medicare immediately upon retirement to avoid potential coverage gaps and late enrollment penalties."  MORE >>

"Employer enthusiasm for artificial intelligence is outpacing employee willingness to use the technology as a tool as part of their benefits programs.... 83% of employers surveyed were interested in using AI to help workers better understand their benefits. Only 58% of employees surveyed said they would use AI for that purpose, and just 24% said they were currently doing so."  MORE >>

"Although many plan obligations are tied either to the calendar year or the plan year, there are two [ACA] items that arise 'off cycle' during the summer months: the Patient-Centered Outcomes Research Institute (PCORI) Fee and Medical Loss Ratio (MLR) rebates."  MORE >>

"Employers that are now receiving settlement proceeds should be aware that they may have fiduciary duties under ERISA with respect to the use of any proceeds from the settlement fund.... Unless specific guidance is issued related to the BCBSA settlement, employers may want to use the [the DOL's prior MLR guidance] as a reference when determining how to calculate what portion of the BCBSA settlement proceeds should be considered 'plan assets,' and how those funds can be used."  MORE >>

"[1] Not filing when a filing is required ... [2] Inaccurate or inconsistent participant counts ... [3] Missing or incomplete Schedule A ... [4] Misapplying Schedule C requirements ... [5] Filing late without using an extension ... [6] Incorrect plan characteristic codes."  MORE >>

"[The final rules] affect how a group health plan communicates with out-of-network providers, participates in payment negotiations, and resolves billing disputes. Because self-insured group health plans are ultimately responsible for ensuring compliance with these new IDR requirements, plan sponsors should work with their third-party administrator (TPA) to confirm that existing processes meet the new standards. Where gaps exist, plan sponsors may want to revise the TPA services agreement to address the requirements summarized below and consider including indemnification provisions or performance guarantees to protect the plan in the event the TPA fails to comply."  MORE >>

"This time of year typically brings key filings such as Form 5500 for calendar-year plans, Patient-Centered Outcomes Research Institute (PCORI) fee payments, Summary Annual Report (SAR) distributions, and medical loss ratio (MLR) rebate considerations, among others. Staying ahead of these requirements is critical to avoiding potential penalties and maintaining compliance with applicable federal laws." [Includes both standard Federal deadlines, and select state and local deadlines.]  MORE >>

"In enforcement actions and audit findings, regulators have consistently identified deficiencies in comparative analyses, particularly where plans cannot adequately document how NQTLs are designed and administered. The most common MHPAEA compliance challenges [include] ... [1] Data access and vendor dependency.... [2] Identifying all applicable NQTLs.... [3] Explaining factors and evidentiary standards ... [4] Demonstrating operational compliance.... [5] Ongoing maintenance obligations.... [6] Fiduciary responsibility.... If this process appears to be complex and overwhelming, that’s because, quite honestly, it is."  MORE >>

"In 2021, the CBO estimated that the newly signed law would lower provider payments, especially out-of-network rates, while reducing commercial insurance premiums by roughly 1% and decreasing federal deficits by $17 billion through 2030. New data suggests a different trajectory, the CBO wrote ... even as the law fulfills its core goal of protecting patients from out-of-network balances on surprise bills. The issue stems from arbitration outcomes that have tilted in favor"  MORE >>

"Ultimately, in order to bridge the benefits trust gap, employees do not need more information. They need better context. Clear explanations, relevant examples, and insight into the rationale behind benefits decisions help employees connect cost, coverage, and value. When that connection becomes clear, trust strengthens. When it remains unclear, confidence declines."  MORE >>

"In deciding whether to distribute the SMM versus an updated SPD, plan administrators should consider the number of modifications that need to be described and whether the use of the SMM alone would sufficiently apprise covered persons of their benefits, rights, and obligations under the plan."  MORE >>

"Under the old USPS rule, a plan sponsor or recordkeeper could reliably mail notices or other important benefits documents the day before a deadline, counting on the postmark reflecting the date the USPS received the mail.... [U]nder the new rule, the same plan sponsor or recordkeeper could miss a deadline if the mail was not automatically sorted until later.... Tax filings and IRS correspondence could attract late-filing penalties. COBRA notices sent even a day 'late' by postmark can expose employers to statutory penalties. Benefit claims and appeals with missed administrative deadlines can result in denied coverage or loss of discretionary review rights. ERISA-required participant notices could be deemed noncompliant."  MORE >>

"[PwC estimated] that medical costs will go up by 9% in the employer market next year, and by 8.5% in the individual market. One of the largest drivers is providers' use of AI-enabled software and scribes that more thoroughly document the care that's delivered.... PwC said the financial impact isn't so much due to people using more medical services as 'changes in coded severity, case mix and paid amount per claim.' "  MORE >>

"Fiduciary oversight in health plan consulting means an advisor accepts legal accountability for acting in the plan's best interest, not just advisory responsibility, but a formal, contractual commitment to prudent plan stewardship. For self-funded employers, understanding why this standard is gaining traction is increasingly important as regulatory scrutiny and litigation risk around health plan management continue to grow."  MORE >>

"The DOL proposed rule (if finalized) and CAA 2026 encourage transparency and accountability between plan sponsors/fiduciaries and PBMs. With detailed initial and semiannual disclosures, drug-level pricing transparency, and enforceable audit rights, plan sponsors and fiduciaries can: [1] Compare PBM models and evaluate which approach delivers the best value. [2] Identify spread pricing exposure at the individual drug level. [3] Attempt to negotiate transparent pass-through compensation arrangements."  MORE >>

"This checklist helps employers understand their obligations and opportunities when an employee notifies them of a new dependent in their family. Questions often arise regarding possible election changes, beneficiary rights and organizational policies. This checklist captures common compliance issues and offers helpful suggestions to avoid complications down the road."  MORE >>

"In an amicus brief ... the ERISA Industry Committee and the American Benefits Council backed Compass Group's bid to appeal a Missouri federal judge's decision to grant class certification in a lawsuit challenging tobacco-use surcharges imposed through the company's health plan." [Mehlberg v. Compass Group USA, Inc., No. 24-4179 (W.D. Mo. Apr. 15, 2025; on appeal to 8th Cir. No. 26-8007)]  MORE >>

"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 >>

"Starting June 11, 2026, the fee for IDR disputes will be lowered from $115 to $15, making the process more accessible for smaller disputes but potentially increasing the system backlog. Health plans and insurers must register in a new IDR registry to help providers correctly identify payors, potentially reducing ineligible or misdirected disputes. The open negotiation period will be managed through the federal IDR portal using standardized forms, with a fifteen-business-day response window, aiming to reduce disputes that are ineligible for IDR."  MORE >>