News Archive

"Instructions for Recipient: This Form 1095-B provides information about the individuals in your tax family (yourself, spouse, and dependents) who had certain health coverage (referred to as 'minimum essential coverage') for some or all months during the year. " [Also available: Draft of 2026 IRS Form 1094-B: Transmittal of Health Coverage Information Returns]  MORE >>

"Employers and plan administrators who sponsor a retirement plan, a group health plan, or any employee plan subject to ERISA, are plan fiduciaries and have very specific fiduciary obligations. But fiduciary duties under ERISA are much more than their enumerated requirements. Plan fiduciaries need to understand this and embrace the mindset that is necessary for ultimate compliance."  MORE >>

"Just 17% of employees plan to get an annual physical this year, -- a 45% decline from 2024 ... Around 60% of respondents reported managing at least one chronic condition, a leading driver of healthcare costs. Notably, every age group over 36 saw double-digit growth in self-reported chronic conditions in 2025 compared to the previous year."  MORE >>

"[T]he interaction between the Proposed Rule and the CAA 2026 was a prevalent theme in the comments.... [C]ommenters made other legal arguments challenging the DOL's authority to proceed with the Proposed Rule ... Many comments addressed the feasibility of the effective date, the scope of the Proposed Rule, and the scope of the proposed audit rights."  MORE >>

"Pharmacy Benefit Manager (PBM) arrangements have long relied on rebates with limited transparency into true drug costs. Recent regulatory and market developments represent a shift toward greater transparency and better net pricing. These developments span a broad range of actors and approaches, including increased regulation of PBMs by the states, legislative, rule-making and agency actions by the federal government, and evolving market-driven responses. This post provides a high‑level overview of key developments and offers practical steps for health plan fiduciaries to consider[.]"  MORE >>

"[T]he Western District of Kentucky addressed two post-remand disputes in a long-term disability benefits case: whether Plaintiff's motion to reopen was prematurely filed and whether Plaintiff was entitled to attorney's fees following a court-ordered remand that the insurer had initiated. The court denied the motion to reopen, denied attorney's fees, and awarded costs only." [Chalk v. Life Ins. Co. of N. Am., No. 25-0133 (W.D. Ky. May 7, 2026)]  MORE >>

"As federal and state governments continue to prioritize drug pricing reform, employers across the nation face a rapidly evolving landscape of legal and regulatory scrutiny regarding the management of their health plans. A convergence of class action ERISA litigation, inquiries from a coalition of 14 states, and increased federal emphasis on health care price transparency has created new compliance challenges and potential areas of risk for plan fiduciaries. Ongoing developments shed light on the implications for employers and compliance considerations for their health plans as related to health care and prescription drug management."  MORE >>

"[This article] examines the unsettled and contested landscape of AI regulation ... It explains how the growing use of AI in group health plans intersects with existing federal laws ... particularly HIPAA ... The discussion highlights unresolved questions about whether training AI on claims data qualifies as permissible healthcare operations and ... further analyzes mental health parity compliance ... The rise of AI and its application to the maintenance and operation of group health plans raises the fiduciary bar exponentially higher."  MORE >>

"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 >>

"[B]usinesses in parts of Southeast Georgia that were affected by wildfires and straight-line winds that began on April 18, 2026 ... now have until Aug. 20, 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 Clinch, Echols, and Brantley counties qualify for tax relief."  MORE >>

"Recent litigation makes clear that ERISA's fiduciary standards apply with full force to group health plans, particularly prescription drug benefits, pharmacy benefit manager (PBM) arrangements, and voluntary benefit offerings.... Beyond litigation defense, a committee structure improves plan operations. Concentrating fiduciary expertise supports more consistent and well‑documented decisions, stronger vendor selection and monitoring, clearer separation between business decisions and fiduciary functions, and enhanced compliance with increasingly complex health plan regulations."  MORE >>

"ERISA plan fiduciaries remain fully responsible for ensuring that AI is used prudently, loyally, and solely in the interest of plan participants, even when AI is deployed by third-party service providers. Because AI systems function as opaque 'black boxes,' fiduciaries face challenges in monitoring their use. Fiduciaries can mitigate risk through reviewing vendor AI policies, requesting audits, requiring compliance with emerging standards ... and negotiating robust AI-specific contract and request for proposal terms addressing transparency, bias, cybersecurity, compliance, and accountability."  MORE >>

"More than 80% of employers believe meaningful healthcare system modernization is achievable within the next few years. Employers are already benefiting from improved tools, processes, and support, while payers continue to face operational complexity -- a gap that signals opportunity for innovation and partnership."  MORE >>

"Paid interns who average at least 30 hours per week are full-time employees under the ACA. Excluding them from group health plan coverage could trigger employer shared responsibility penalties ... Full-time paid interns may be excluded from coverage without penalty exposure if they qualify as seasonal employees under a properly structured measurement period. The key word is 'properly.' "  MORE >>

"Health systems, hospitals, physician practices, electronic health record (EHR) vendors, and digital health developers are now joining payers as a unified coalition aligned around a single mission: making electronic prior authorization work end-to-end, on time, for every patient. Committed working groups across these stakeholders will align on CMS Interoperability and Prior Authorization Final Rule deadlines, addressing workflow gaps and technical handoffs that no single sector can fix alone. Prior authorization touches every part of the health care system; now, every part has a seat at the table."  MORE >>

"The court next addressed the insurer's structural conflict of interest because it served as both the LTD plan's administrator and insurer. It noted that abuse of discretion review is 'tempered by skepticism' and that conflict is to be considered. However, the court gave this conflict little weight because the insurer's determination was supported by the results of a thorough, neutral and independent review process." [Wallace v. Hartford Life Ins. Co., No. 25-2716 (9th Cir. Apr. 17, 2026)]  MORE >>

"Enrollment may be over, but your communication shouldn’t stop. Here’s how to talk to your employees year-round to help them appreciate their benefits and make smart decisions."  MORE >>

"[In-house] administration offers maximum control over how your organization allocates its HR budget and resources ... While outsourcing may not always be the least expensive option, it is often the most cost-effective solution in the long run ... Co-sourcing blends some strengths of in-house and outsourced solutions, offering flexibility for organizations with diverse needs or complex structures.... [F]ocus on the complexity of your benefits plans, the scale of your administrative workload, your employee experience priorities, your technology capabilities, and your preferred level of control and collaboration."  MORE >>

"[I]ndividuals and businesses affected by Super Typhoon Sinlaku in the Commonwealth of the Northern Mariana Islands that began on April 11, 2026 ... now have until Nov. 2, 2026, to file various federal individual and business tax returns and make tax payments.... [I]ndividuals and households affected by Super Typhoon Sinlaku that reside or have a business in the Northern Islands, Rota, Saipan and Tinian qualify for tax relief."  MORE >>

"Under Section 4980H(c)(5), in the case of any calendar year after 2014, the applicable dollar amounts of $2,000 and $3,000 under Section 4980H(c)(1) and (b)(1), respectively, are increased by an amount equal to the product of such dollar amount and the premium adjustment percentage for the calendar year.... (HHS) published the premium adjustment percentage for 2027 on January 29, 2026  ... For calendar year 2026, the adjusted $2,000 amount under Section 4980H(c)(1) is $3,780, and the adjusted $3,000 amount under Section 4980H(b)(1) is $5,670."  MORE >>

"Creditable prescription drug coverage is defined as coverage that is equal to or greater than the actuarial value of standard Medicare Part D coverage.... Plan sponsors can determine creditable status using either a simplified determination method or an actuarial evaluation. Employer Group Waiver Plans (EGWPs) and Retiree Drug Subsidy applicants are required to use actuarial valuation.... CMS introduced a new simplified determination -- optional in 2026 and mandatory in 2027 and beyond. The only change from 2026 to 2027 is a one percentage point increase in required value."  MORE >>

22 pages. "The purpose of this [report] is to inform ERISA health plan sponsors and trustees about why it is vital to address provider errors -- meaning recovering provider overpayments and correcting underpayments. The report also offers advice for choosing a vendor specializing in these services.... Administrators of self-funded health plans bear a fiduciary responsibility under ERISA to protect plan assets, which includes proactively pursuing and recovering any overpayments. Equally critical is the fiduciary obligation to ensure that providers are not undercompensated to the detriment of plan participants."  MORE >>

"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 >>

"Self-funded ERISA plans in Tennessee are not required to admit any-willing-provider to their networks or to refrain from financial incentives that direct participants to preferred pharmacies. Plan sponsors retain the flexibility to design pharmacy benefit programs, including tiered networks, cost-sharing differentials, and preferred pharmacy arrangements, without interference from the invalidated Tennessee provisions." [McKee Foods Corporation v. BFP Inc., No. 25-5416 (6th Cir. Apr. 7, 2026)]  MORE >>

"For a variety of legal, structural, and practical reasons, employers seem to struggle to determine which benefit plans are covered by ERISA and which are not. This isn't because employers are careless or uninformed; it's because ERISA is one of those laws where the line between 'covered' and 'not covered' is skewed by how benefits are actually bought and administered."  MORE >>