News Archive

"[S]everal recent federal district court decisions now provide the first substantive rulings on these issues. Notably, each court dismissed the plaintiffs' claims in full, signaling a trend that is generally favorable to employers. That said, this remains an actively litigated area, with dozens of similar lawsuits pending nationwide. Employers should continue to monitor developments and ensure compliance with applicable wellness program rules."  MORE >>

"We are seeing the migration of 401(k)-style fiduciary claims to health plans, accelerated by transparency requirements established by the Consolidated Appropriations Acts of 2021 and 2026. The unifying question is often not whether a single rule was violated, but whether the plan sponsor followed a prudent fiduciary process."  MORE >>

"AI is changing medical imaging by finding cancers earlier and making it easier for doctors to diagnose cancer. Billing inconsistencies and the lack of standardized codes pose problems.... Payment for these advances will be a challenge for employer-sponsored health insurance."  MORE >>

"Rhode Island ... became the first state to explicitly prohibit menopause discrimination and require workplace accommodations ... A significant gap exists in federal law, leaving employees to rely on overlapping protections (sex, age, disability) ... [M]ore states are likely to follow and menopause-related claims are already gaining traction -- making it important to consider accommodations and policy updates now."  MORE >>

"This white paper examines state reinsurance programs through a financial and actuarial lens.... [The authors] highlight how reinsurance transforms previously unbounded risk into manageable exposure and creates new strategic opportunities for payers ... [and] explore how insurers can leverage these dynamics through condition-specific product strategies and consider the implications of a potentially shrinking ACA market on 1332 waiver funding and the long-term sustainability of reinsurance programs"  MORE >>

"The Sixth Circuit determined that the Tennessee any-willing-provider provision impermissibly restricted self-funded ERISA plans because by removing the plan sponsor's choice of pharmacy network providers, the law effectively made network decisions, which were 'a central matter of plan administration,' and required plans to be designed in a particular way.... The incentive and disincentive provisions were also held to be impermissible restrictions on self-funded ERISA plans by dictating key plan design and structure requirements[.]" [McKee Foods Corporation v. BFP Inc., No. 25-5416(6th Cir. Apr. 7, 2026)]  MORE >>

"How do you prepare for thousands of dollars in upfront costs? One option is a health savings account, or HSA, which lets you save pretax money and is now available to people enrolled in lower-tier state and federal exchange plans, including bronze and catastrophic coverage. These plans generally have the lowest premiums on the exchange but the highest out-of-pocket costs when you need care."  MORE >>

"We need to make transparency non-negotiable. Full disclosure of administrative fees, rebates and spread pricing practices is essential to ensure PBM incentives align with the best interests of employers and their people. Furthermore, we need to remove members from the position of choosing between cost savings or coverage protection. We need to deliver both to health plan members. Can PBMs be a thing of the past? The question may not be whether PBMs will disappear entirely, but how their role will evolve or even begin to shrink."  MORE >>

"[T]he court held that participants who received every promised benefit could still demonstrate injury in fact under Thole... by alleging they paid too much for that coverage. Second, the court declined to resolve the settlor doctrine defense at the motion to dismiss stage, holding that whether Northwestern's decisions regarding the design of coverage options constitute fiduciary or settlor functions is a 'fact-intensive' inquiry better suited for summary judgment." [Barbich v. Northwestern Univ., No. 25-6849 (N.D. Ill. Apr. 2, 2026)]   MORE >>

17 pages. "This guidance paper deals specifically with questions about preemption of state PBM laws under [ERISA] ... [It] provides some guidance related to ERISA preemption by undertaking an analysis of the different types of state PBM laws and considering how appellate courts have applied the reasoning in Rutledge to those laws."  MORE >>

"The lawsuit ... claims Northwestern violated its fiduciary duty as a plan sponsor under [ERISA]. According to the complaint, the university offered multiple preferred provider organization health plans but failed to properly evaluate and disclose that one option -- the higher-premium 'Premier PPO' -- provided no meaningful advantage over cheaper alternatives." [Barbich v. Northwestern Univ., No. 25-6849 (N.D. Ill. Apr. 2, 2026)]  MORE >>

"65% of employed adults would be more likely to use a GLP-1 medication if their employer covered at least part of the cost. Another 56% said they would be willing to pay out of pocket if their employer offered a behavioral support program to help manage weight loss."  MORE >>

30 pages. "This reform agenda is designed as a 'bill of rights' to ban abuses that deny care, lower deductibles, and stop premium shocks -- in other words, to respond to the growing feeling that health insurance costs too much and offers too little value or protection. A key theme of this report is that markets in health care are highly concentrated, driving up medical prices and premiums."  MORE >>

"In these many situations where AI increases productivity without necessarily improving accuracy or outcomes, or when AI can perform services autonomously, current payment paradigms that reimburse based on human labor inputs like time and skill just don’t fit well.  This may lead to overspending and overuse, which must be balanced with the health benefits of access to the technologies."  MORE >>

"[T]he court held that both categories of PBM laws had an impermissible 'connection with' ERISA plans under 29 U.S.C. Section 1144(a). Applying the framework from Rutledge and Gobeille ... the court identified three independent grounds for preemption: the laws [1] required providers to structure benefit plans in a particular way, [2] governed a central matter of plan administration, and [3] interfered with nationally uniform plan administration." [McKee Foods Corporation v. BFP Inc., No. 25-5416(6th Cir. Apr. 7, 2026)]  MORE >>

"Many people ages 18 to 49 fall outside the recommended proactive guidelines for key cancer screenings, which typically start at 40 or 45.... Cancer rates are rising among young adults, and many people are diagnosed earlier in life than expected.... As medical expenses continue to climb, particularly for advanced-stage diagnoses and treatments, employers must shift their focus from reactive sick care to proactive health care."  MORE >>

"The trend is being observed most clearly among Michigan employers with workforces ranging from 50 to 500 employees ... What was once considered a niche or experimental approach has matured into a legitimate and well-supported strategy that mid-market HR teams are actively evaluating and, in many cases, implementing."  MORE >>

90 pages. "This report presents statistics and data on announced transactions that include life and health insurance business ... Following a year-on-year rise in volumes in 2024, the number of announced life and health M&A transactions across the globe remained unchanged in 2025 (85 deals).... Looking ahead, insurers in North America are expected to increasingly focus on strategic initiatives driving organic growth."  MORE >>

"Employers facing tobacco-surcharge litigation have stronger authority to argue that removing the surcharge prospectively after completion of a cessation program satisfies ERISA's 'full reward' requirement without retroactive refunds.... By treating wellness program adoption as a settlor function rather than a fiduciary act, the courts provide additional grounds to defeat fiduciary-breach claims tied to the design and funding effects of these programs."  MORE >>

"Billionaire Mark Cuban is calling for the breakup of large, vertically integrated health insurers, arguing that rising employer health care costs are quietly stifling hiring, wages and affordability.... [T]he billionaire contends that, for many companies, health benefits have effectively become a second payroll line, and that complex, multi-entity insurance structures are helping to drive those costs higher while obscuring where margins are made."  MORE >>

"From implementing new tax laws, a flurry of executive orders with implications for both retirement and welfare plans, updated agency guidance, increased litigation and enforcement activity, and updates to longstanding requirements, plan fiduciaries have a great deal to manage as they work to stay current. Layered onto these federal developments is a growing patchwork of state and local regulation. Jurisdictions continue to expand mandated benefits, including insurance coverage requirements and state retirement savings programs. For plan sponsors operating across multiple jurisdictions, coordinating compliance has become not only an administrative challenge, but a strategic one."  MORE >>

"Like defined benefit pension plans, self-funded group health plans place the residual risk of payment on the employer. While there are mechanisms to smooth or reduce some of the payment risk, the plan sponsor is ultimately responsible for ensuring that promised benefits are paid in compliance with the terms of the plan. In both contexts, the participant's protected interest begins and ends with the employer's promise of future benefits, not the participant's preferred method of fulfillment. Participants do not suffer a concrete injury merely because they disagree with how the employer's promises are fulfilled."  MORE >>

"A recent settlement by the Trump administration has made it clear that it intends to enforce parity compliance when it comes to proper access to mental health and substance use disorder services.... In addition to paying a $32 million settlement, Kaiser has agreed to improve monitoring of its behavioral health network for adequacy. According to EBSA, Kaiser violated parity regulations by failing to have sufficient mental healthcare and substance abuse treatment providers in its network."  MORE >>

"Family offices are understandably private, with many aspects of their operations shrouded in secrecy, including their investments, family members, ownership details and the structures designed to protect them.... Assessing which entities are part of the 'family' enables holistic advice on the family office's obligations, including whether employee benefits must be offered and whether the benefits provided are compliant with current rules. This becomes more complex for family offices with a global scope, particularly if the original family is unfamiliar with U.S. regulations and is hesitant to allow deeper review of the broader structure."  MORE >>

"There's a real chance Pennsylvania lawmakers could begin requiring employers to provide paid parental and medical leave, supporters say, though there are still critical disagreements on who should carry the cost. The Democratic-controlled state House passed a paid leave bill in late March, the first time such a policy has cleared a chamber after at least seven years of debate on the issue."  MORE >>