"In late January, [EBSA] released a proposed rule ... which focused on methods of improving transparency around the fees and compensation that Pharmacy Benefit Managers (PBMs) receive. One week later ... the President signed the Consolidated Appropriations Act of 2026 (CAA 26) into law. This law puts the proverbial target on the backs of PBMs by requiring not only more transparency, but also new reporting on PBM rebates, price spreading, and compliance. The combination of these new regulatory developments has the potential to alter the role and work of PBMs and how they interact with employer-sponsored group health plans." MORE >>
"A spouse's enrollment in a general purpose health FSA provides 'coverage' (i.e., the ability to have out-of-pocket medical expenses reimbursed) for both the spouse and the employee. Because the general purpose health FSA is disqualifying coverage for HSA eligibility purposes, the spouse's FSA enrollment blocks both the spouse and the employee from making or receiving HSA contributions." MORE >>
"Dependent eligibility audits have become one of the more practical tools available to plan sponsors to ensure that the plan operates in accordance with its own terms, as well as to help in controlling plan expenses.... [1] Understand the terms of plan documents first ... [2] Design the process -- and stick to it ... [3] Know the ACA's anti-rescission rule ... [4] Understand when COBRA does -- and doesn't -- apply ... [5] Address Section 125 implications in advance ... [6] Protect personal information ... [7] Communicate clearly -- and early ... [8] Build better processes for the future." MORE >>
"Establishing your objectives for using AI in benefits administration may help provide clarity in choosing a benefits administration provider that can support your goals. Successful benefits administration providers will be able to cleanly connect multiple data sources to provide purposeful integration of data-driven technology and AI." MORE >>
"DOL regulations provide model language and a basic format. In addition to the plan name, EIN, and type of welfare plan, welfare plan SARs must include the following information: [1] Funding and insurance information.... [2] Financial information.... [3] Rights to additional information." MORE >>
"Generally, documents sent by mail are considered timely if they are postmarked on or before the applicable due date. In the past, mail dropped off at the post office or put in a public mailbox before the final pickup time would be postmarked that same day. Under the new process, a same-day postmark is no longer certain." MORE >>
"When both spouses are employed by the same organization and benefit-eligible, each is independently eligible to enroll in the group health plan as an employee.... A more complex question is whether the plan allows for dual coverage under the plan.... [M]any employers contribute significantly more to the employee-only tier of coverage than to tiers that include spouses and dependents.... This presents a dilemma when spouses work for the same employer." MORE >>
"Hartford moved for summary judgment on the sole ground that Bianchini failed to exhaust administrative remedies. The court denied Hartford's motion, holding that Hartford's procedural violations of 29 C.F.R.§ 2560.503-1 deemed Bianchini's administrative remedies exhausted." [Bianchini v. The Hartford Life and Accident Ins. Co., No. 24-6535 (S.D.N.Y. Mar. 24, 2026)] MORE >>
"This final rule implements requirements of the Administrative Simplification subtitle of [HIPAA and the ACA] ... Specifically, this final rule adopts standards for health care claims attachments transactions, which will support health care claims transactions, and a standard for electronic signatures to be used in conjunction with health care claims attachments transactions." MORE >>
"Brokers said the top ways carriers could support employers include enhancing enrollment tools and communication materials, communicating the value proposition for voluntary benefits, and offering more customizable product options.... Brokers expect strong growth in core and supplemental benefits, reflecting broader budget optimism.... Employers value the impact benefits have on morale more than brokers do.... Brokers believe education support from carriers could help boost employee adoption of supplemental health benefits.... Administrative complexity is a challenge to the adoption of supplemental health benefits." MORE >>
"The Department of the Treasury (Treasury Department) and the [IRS] invite the public to submit recommendations for items to be included on the 2026-2027 Priority Guidance Plan.... Please submit recommendations for guidance by Friday, May 29, 2026, for possible inclusion on the original 2026-2027 Priority Guidance Plan." MORE >>
"For plan sponsors, the issue is less about the use of AI itself and more about whether existing claims oversight and payment-integrity controls are keeping pace with increasingly automated billing environments. While these technologies improve efficiency, they also introduce a growing risk for self-insured health plans: an increase in duplicate and near-duplicate claims." MORE >>
"Over the past decade, private equity has significantly accelerated consolidation across the retirement and benefits industries.... For plan sponsors, the key takeaway is not to avoid PE-backed firms -- but to ensure that evaluation processes remain objective, transparent, and well documented." MORE >>
"While AI can enable PBMs to operate more efficiently and optimize pricing to help lower drug costs, this new technology raises several data privacy, regulatory, and contractual risks for employers that sponsor health plans. This Insight explains how plan sponsors can spot potential red flags and avoid potential liability while benefiting from the advantages that AI can bring to healthcare costs and administration." MORE >>
"A committee to which fiduciary duties are delegated helps the employer fulfill its responsibilities and offers several key advantages: [1] Delegation and accountability ... [2] Better decision-making ... [3] Risk management ... [4] Vendor oversight ... [5] Stronger documentation." MORE >>
"Overall, the data show a significant uptick in the volume of IDR cases and corresponding administrative costs. This article also offers a brief update on recent developments in litigation over the No Surprises Act, which has contributed to a more costly IDR system. Indeed, many lawsuits in the most recent wave of litigation -- in which payers are suing high-volume IDR middlemen and providers -- reflect allegations that are consistent with the trends observed in the data below." MORE >>
"Early 2026 brought two major federal actions that reshape how pharmacy benefit managers (PBMs) are regulated and how plan fiduciaries oversee prescription drug benefits. ... Together these changes send a clear message that PBM arrangements are no longer something plan sponsors can treat as too technical or complicated to understand. Fiduciaries are expected not only to obtain PBM data but to evaluate it, document decisions, and monitor PBM performance over time." MORE >>
"Rewards such as lower major medical plan premiums or additional employer contributions to a health FSA, HRA, or HSA would be excluded from an employee's income and would not be subject to income or employment tax withholding, provided that applicable nondiscrimination requirements are satisfied. But rewards that take the form of cash or cash equivalents (e.g., gift cards or gift certificates) are subject to federal income and employment taxes and withholding. They are also reportable on the recipient's Form W-2." MORE >>
"AI tools are increasingly used in benefits administration.... While these tools can improve efficiency, they also introduce new cybersecurity risks that fiduciaries must evaluate.... Based on the DOL's guidance and emerging best practices, fiduciaries should consider implementing the following measures: [1] Vendor due diligence.... [2] Contractual protections.... [3] Participant education.... [4] Employee education.... [5] Documentation." MORE >>
"Nearly two-thirds of Americans live paycheck to paycheck, making it critical that benefits communication doesn't treat health and financial wellness as separate conversations. This article outlines how employers can build year-round communication strategies—beyond annual enrollment—that connect daily spending, debt, HSA contributions, and long-term savings into a coherent picture." MORE >>
"For [employee benefit plans] and labor organizations, aligning internal controls with risk is essential to effective governance. Applying a structured framework and adapting controls to the nature of the risks, helps strengthen governance, protect assets, and build trust with stakeholders." MORE >>
"While common benefits concepts are explained during enrollment, employees rarely understand how they work together. This only occurs when they attempt to use their employer sponsored benefits, often under stress, during a health crisis.... Employers making progress are shifting away from one‑time education and toward ongoing, personalized support that helps employees interpret, anticipate, and navigate their benefits when expectations and reality don't align." MORE >>
"This alert highlights key filing, notice, contribution, and reporting obligations commonly applicable during the April-June timeframe, including ERISA plan filings, health plan reporting, and HSA-related actions." MORE >>
