News Archive

"As part of the Bipartisan Budget Act of 2019, the PCORI annual filing and fees were reinstated for an additional 10 years, through 2029. That means that all employers (or their insurers in fully insured group health plans) must file the annual IRS Form 720 by July 31st of each year, regardless of their plan year."  MORE >>

"Employers across the country routinely receive a Letter 226-J from the IRS proposing an [ESRP], often running well into six or seven figures, for a tax year that may be several years in the past. Each of these letters contains a single sentence that the IRS treats as the foundation of the entire assessment.... This article lays out the statutory framework, explains in detail why a Letter 226-J is not a Section 1411 notice, walks through the Faulk decision, and shows how Loper Bright independently dooms the government's reading of the statute. It closes with what an employer holding a Letter 226-J should do now."   MORE >>

"Outrageous provider-driven abuse of the No Surprises Act is adding billions in wasteful spending and raising healthcare costs for everyone. Policy action is needed to address flawed incentives in the IDR process and protect consumers from unconscionable price gouging by out-of-network providers and IDR middlemen[.]"  MORE >>

"The defendants argued that an unintentional error in counseling cannot support a fiduciary breach claim unless the plan language on the same topic is also ambiguous. The court rejected that argument, reasoning that ERISA imposes an affirmative duty on fiduciaries to convey complete and accurate information material to a beneficiary's circumstances, even when the beneficiary has not asked." [Williams v. Lawrence Livermore National Security, LLC Benefits and Investment Committee, No. 24-7593 (N.D. Cal. June 29, 2026)]  MORE >>

"The use of artificial intelligence does not lower the fiduciary standard. It does not allow fiduciaries to outsource judgment. It does not excuse weak oversight. And it does not allow a plan sponsor to say, 'The system made the decision,' as if that ends the discussion.... Fiduciary review cannot stop at cost, convenience or a polished sales presentation. Plan fiduciaries should understand what the tool does, what data it uses, how outputs are reviewed and whether a human remains involved."  MORE >>

22 pages; Rev. Jun. 2026."What's New: Sections 4375 and 4376 patient-centered outcomes research fee increase. The fee for policy and plan years ending on or after October 1, 2025, but before October 1, 2026, is increased to the applicable rate of $3.84 ... The fee for policy and plan years ending on or after October 1, 2024, but before October 1, 2025, remains at the applicable rate of $3.47 ... File Form 720 annually to report and pay the fee on the second-quarter Form 720 no later than July 31 of the calendar year immediately following the last day of the policy year or plan year to which the fee applies." [Also available: IRS Form 720, Quarterly Federal Excise Tax Return (Rev. Jun. 2026)]  MORE >>

"The filing and payment to the IRS is due by July 31, 2026, and applies to policy and plan years ending during the 2025 calendar year. The applicable PCORI fee is based on the plan year-end date: $3.84 per covered life for plan years ending on or after Oct. 1, 2025 and before Oct. 1, 2026; $3.47 per covered life for plan years ending before Oct. 1, 2025."  MORE >>

"The Final Rule is effective August 3, 2026, with staggered applicability dates for specific provisions. The Final Rule represents the most comprehensive revision to the Federal IDR process since its establishment. Key Takeaways [1] Reduction in administrative fees ... [2] Comprehensive open negotiation reforms ... [3] Standardized communication codes ... [4] Revised batching rules and 50-item cap ... [5] New plan and issuer registration requirement."  MORE >>

"If your company sponsors a health plan, especially a self-funded one, there is a good chance that you, or someone on your team, is an ERISA fiduciary. Most people in that position have never been told so. Here is what the role requires, why it has become one of the fastest-growing areas of litigation and enforcement risk for employers, and what to do if a claim or an investigator ever comes knocking."  MORE >>

"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 >>