News Archive

"Following a review of the DFVC Program, as modified in 2002 and 2013, the Department has determined to expand the penalty relief to plan MEWAs, non-plan MEWAs, and ECEs who are required to file the Form M-1.... The Department, to encourage voluntary compliance with ERISA's reporting requirements, is extending to plan and non-plan MEWAs and ECEs that are required to file Form M-1 the same $750 maximum penalty amount currently available to small plans filing a late Form 5500, and to filers of apprenticeship and training plans and top hat plans. In addition, top hat and apprenticeship plans will no longer be directed to the DFVC payment calculator. All plans eligible to pay a flat $750 fee will follow a link to a gov.pay site.... The DFVC Program described herein shall be effective December 19, 2025."  MORE >>

"The standard mileage rate for transportation or travel expenses for 2026 is 72.5 cents per mile for all miles of business use (business standard mileage rate) ... The standard mileage rate is 14 cents per mile for use of an automobile in rendering gratuitous services to a charitable organization under Section 170.... The standard mileage rate for 2026 is 20.5 cents per mile for use of an automobile: [1] for medical care described in Section 213; or [2] as part of a move for which the expenses are deductible under Section 217(g)."  MORE >>

"This Fact Sheet updates frequently asked questions (FAQs) about the Premium Tax Credit. The revisions and additions are as follows: [1] Updates to questions related to the limitations on repayment of excess advance payment of the premium tax credit due to the removal of the limitations for tax years beginning after Dec. 31, 2025. [2] Updates throughout for minor style clarifications and topic/question renumbering. [3] Deletion of questions Q 32 and Qs 35-49 about certain Premium Tax Credit rules that do not apply after tax years 2020 and 2021."  MORE >>

"A recent [District Court decision] is a helpful reminder that insurers do not get to 'ERISA-wash' a claim simply because coverage was offered to employees through an employer channel. When the employer stays neutral, employees pay the full premium, and the insurer sells what is functionally an individually owned policy governed by state law, ERISA may never come into play -- no matter how aggressively the insurer invokes it after a claim dispute arises." [Koo v. Unum Grp., No. 25-5797 (C.D. Cal. Dec. 16, 2025)]  MORE >>

"[I]ndividuals and businesses in the State of Washington affected by severe storms, straight-line winds, flooding, landslides, and mudslides that began on Dec. 9, 2025 ... now have until May 1, 2026, to file various federal individual and business tax returns and make tax payments.... [I]ndividuals and households that reside or have a business in Benton, Chelan, Clallam, Grays Harbor, Jefferson, King, Kittitas, Lewis, Mason, Pierce, Samish, Skagit, Snohomish, Thurston, Wahkiakum, Whatcom, and Yakima counties qualify for tax relief."  MORE >>

"If EOI is required, coverage does not exist until it is approved. However, courts often are unforgiving to employers when an EOI failure surfaces after death or disability, thus opening risk to breach of fiduciary duty claims or equitable relief. Plan administrators that proactively manage EOI and communicate clearly can avoid costly disputes when it matters most."  MORE >>

"Among states in 2023, the highest average in-network denial rate was 34% (Alabama), with the lowest in South Dakota (6%), perfectly illustrating the wide national variance in claim denials. Whereas, in Florida, the average in-network denial rate was 16%, with individual insurers varying between 8% to 54%, emphasizing the potentially enormous non-network differential."  MORE >>

"[T]wo areas [for PBMs to] focus on in the coming months ... [1] Operate with full clarity on money flow and decision-making (i.e., clearly defined administrative fees) while making the whole process accessible and visible to your clients.... [2] [C]harge a clear administrative fee and return every rebate and discount to the client. This can help your PBM regain trust and relieve some of the strain that could lead clients to seek alternate options."  MORE >>

"This fact sheet discusses the proposed provisions of the Transparency in Coverage proposed rule that would amend the 2020 final rules.... [1] Improved standardization, accuracy, and accessibility of the in-network rate and out-of-network allowed amount machine-readable files ... [2] Disclosures to participants, beneficiaries, and enrollees: internet-based self-service tool."  MORE >>

"Key improvements [in the proposed rule] include: [1] Requiring plans and issuers to exclude from the In-network Rate Files certain data for services providers would be unlikely to perform. [2] Reorganizing In-network Rate Files by provider network rather than by plan ... [3] Requiring Change-log and Utilization Files so users can easily identify what has changed from one In-network Rate File to the next ... [4] Reducing reporting cadence for In-network Rate and Allowed Amount Files from monthly to quarterly,"  MORE >>

"The prohibition of gag clauses is more than an annual attestation; it requires active oversight of all plan-related contracts.... [E]mployers should: [1] Audit contracts with TPAs, PBMs, and carriers ... [2] Verify downstream compliance ... [3] Document efforts to remove any prohibited clauses ... [4] Submit your attestation on time if your carrier or TPA does not handle it on your behalf."  MORE >>

"As your organization prepares to implement your new system, it is crucial to safeguard this major investment by taking steps now to avoid costly mistakes later.... [F]our proven strategies for a seamless benefits administration system implementation: ... [1] Gather all functional requirements ... [2] Clean your data before the system conversion ... [3] Create a detailed testing plan ... [4] Train, train, train! "  MORE >>

"ERIC has long advocated that Congress enact strong PBM transparency and accountability reforms to provide relief for employers and workers nationwide. In addition to applying fiduciary standards to PBMs, ERIC has called for PBM reforms to foster greater accountability and affordability by: [1] Providing comprehensive PBM transparency. [2] Banning so-called “spread pricing.” [3] Requiring 100% pass-through of rebates and payments from drug manufacturers."  MORE >>

241 pages. "These proposed rules set forth proposed requirements that would amend the regulations under the Public Health Service Act, [ERISA] and the Internal Revenue Code regarding price transparency reporting requirements for non-grandfathered group health plans and health insurance issuers offering non-grandfathered group and individual health insurance coverage. Specifically, these proposed rules would improve the standardization, accuracy, and accessibility of public pricing disclosures in line with the goals of the Executive Order 14221. With respect to the in-network rate and out-of-network allowed amount machine-readable files, these proposed rules would achieve these goals by adding new contextual files and additional data elements like product type, network name, and enrollment counts; changing the reporting level for aggregation of data; removing in-network rates for unlikely provider-to-service mappings; increasing the reporting period and lowering the claims threshold for out-of-network historical data; and reducing the reporting cadence. These proposed rules would also improve the findability of all of the publicly disclosed machine- readable files required under the Transparency in Coverage rules, including the prescription drug file, by requiring a text file and footer with website URLs and contact information for the files. These proposed rules would also require pricing information that is made available through an online consumer tool and paper (upon request), to also be made available by phone, and establish that the satisfaction of such requirement also satisfies the requirements of section 114 of the No Surprises Act (including for grandfathered group health plans and health insurance issuers offering grandfathered group and individual health insurance coverage that are not otherwise subject to these proposed rules)."  MORE >>

"Eligible small employers (defined later) use Form 8941 to figure the credit for small employer health insurance premiums for tax years beginning after 2009. For tax years beginning after 2013, the credit is only available for a 2-consecutive-tax-year credit period. " [Also available: 2025 IRS Form 8941]  MORE >>

"CMS explains in the proposal's preamble that account-based plans are designed to provide cost savings through pre-tax contributions and reimbursements, and often supplement other coverage, rather than actually offering prescription drug coverage. Thus, the benefit design of account-based plans makes concepts such as the disclosure of creditable coverage inapplicable and unduly burdensome[.]"  MORE >>

"[T]he Fifth Circuit affirmed the denial of Aetna's motion to compel arbitration and stay litigation, holding that [1] the parties did not clearly and unmistakably delegate questions of arbitrability to an arbitrator, and [2] the plan's ERISA claims seeking monetary relief against a fiduciary constitute equitable relief and therefore fall outside the scope of the arbitration clause." [Aramark Servs., Inc. Grp. Health Plan v. Aetna Life Ins. Co., No. 24-40323 (5th Cir. Dec. 18, 2025]  MORE >>

"Employers can reduce hidden healthcare costs by using claims and pharmacy data to identify wasteful spend, steering members to high-value providers, tightening pharmacy benefit design, and investing in population health, care navigation, and social determinants of health strategies that improve outcomes and reduce avoidable utilization. [This article unpacks] what is driving costs, where waste hides in your plan, and the practical steps employers can take now to break the cycle."  MORE >>

"Managing employee benefits can overwhelm lean HR teams, especially without a dedicated benefits function. This guide shares 19 practical strategies to reduce administrative burden, streamline support, and empower employees to self-serve. With the right partners, tools, and systems, even small HR teams can deliver a confident, effective benefits experience."  MORE >>

"The current focus on ghost networks provides a timely catalyst for health plans to strengthen their provider data management processes. A good first step is defining what accuracy and completeness mean for your organization. Set measurable standards; for example, determine how often data must be updated and what percentage of records must be verified at each cycle."  MORE >>

"Organizations invest heavily in benchmarking, employee surveys, and high-demand perks like flexible work arrangements and mental health resources. But offering competitive programs is only half the equation. What matters is how employees perceive the value and applicability of those programs."  MORE >>

"Plan sponsors should be collaborating with their payroll vendors and recordkeepers to understand how mandatory Roth catch-up contributions will be processed for high wage earners ... [If] at least one applicable retirement plan within a controlled group permits super catch-up contributions, all controlled group retirement plans must also permit super catch-up contributions.... By February 16, 2026, each HIPAA covered entity and business associate must update its Notice of Privacy Practices (NPP) ... Some section 409A corrections under Notice 2008-113 must be completed by year-end, making now the ideal time to identify and finalize correction of any lingering errors."  MORE >>

"Of interest for 401(k) plans and health and welfare plans is a clarification regarding reporting of delinquent participant contributions on Schedule DCG, Schedule H, or Schedule I, as applicable.... References to the Voluntary Fiduciary Correction Program have been updated to reflect the most recent version (issued in early 2025). ... Other changes relate to defined benefit plans."  MORE >>

"[K]ey considerations and action items plan sponsors should address prior to the end of this year or at least prioritize in early 2026: [1] Telehealth coverage -- to charge or not to charge ... [2] Dependent care contribution limits -- should you increase the limit? ... [3] Direct Primary Care Arrangements -- some arrangements can be paired with an HSA.... [4] Remember gag clause attestations.... [5] Revisit last year's ACA reporting 'present'.... [6] Update HIPAA Notice of Privacy Practices.... [7] Mental Health Parity & Addiction Equity Act (MHPAEA) NQTL compliance still required.... [8] Routine year-end housekeeping."  MORE >>

"[HHS has] published a proposed rule ... that would carve out account-based group health plans from the requirement to provide a Medicare Part D-creditable coverage notice to Part D-eligible individuals. This exclusion would be welcome relief for account-based plan service providers and plan sponsors who offer an individual coverage health reimbursement arrangement (ICHRA) or another type of account-based group health plan, such as a health care flexible spending account (FSA), health savings account (HSA), or traditional health reimbursement arrangement (HRA)."  MORE >>