News Archive

"For calendar year 2027, the annual limitation on deductions under section 223(b)(2)(A) for an individual with self-only coverage under a high deductible health plan is $4,500. For calendar year 2027, the annual limitation on deductions under Section 223(b)(2)(B) for an individual with family coverage under a high deductible health plan is $9,000.

"For calendar year 2027, a DPCSA is not treated as a health plan with respect to an otherwise eligible individual if the aggregate monthly fees for all DPCSAs with respect to the individual do not exceed $150 or, if the individual is covered by a DPCSA that covers more than one individual, $300.

"For calendar year 2027, a 'high deductible health plan' is defined under section 223(c)(2)(A) as a health plan with an annual deductible that is not less than $1,750 for self-only coverage or $3,500 for family coverage, and for which the annual out-of-pocket expenses (deductibles, co-payments, and other amounts, but not premiums) do not exceed $8,700 for self-only coverage or $17,400 for family coverage.

"For plan years beginning in 2027, the maximum amount that may be made newly available for the plan year for an excepted benefit HRA under Section 54.9831-1(c)(3)(viii) is $2,250."  MORE >>

"For employers that already provide fertility benefits through their major medical plans and/or through fertility HRAs, it is unclear whether an employer would terminate their existing fertility arrangement in favor of an excepted fertility benefit program that has set dollar limits, or adopt an excepted fertility benefit to supplement their existing fertility coverage.... Excepted benefit status may assist employers who sponsor a fertility HRA to avoid the ACA-HRA integration rules[.]"  MORE >>

"Beginning with the 2027 plan year, insurers will no longer be required to offer standardized plans ... HHS now believes that these plans are 'an ineffective strategy' to simplify the plan selection process, improve the consumer experience, and increase consumer understanding.... The final rule permanently removes the option for insurers to use fixed-dollar and gross-premium threshold flexibilities beginning with the 2027 plan year.... [T]he final rule will largely continue current risk adjustment policies, with narrow exceptions.... The final rule adopts a [risk adjustment] user fee rate of $0.18 per member per month for the 2027 benefit year, a slight decline from the $0.20 per member per month fee that applied for the 2026 benefit year."  MORE >>

38 pages. "This 2027 Final Letter provides updates on operational and technical guidance for the 2027 plan year for issuers seeking to offer qualified health plans (QHPs), including stand-alone dental plans (SADPs), in the Federally-facilitated Exchanges (FFEs) or the Federally-facilitated Small Business Health Options Programs (FF-SHOPs). It also describes how parts of this 2027 Final Letter apply to issuers in State-based Exchanges on the Federal Platform (SBE-FPs).... The 2027 Final Letter focuses on guidance that has been updated for the 2027 plan year[.]"  MORE >>

"The proposed rule would permit, but not require, plans to offer coverage on a limited excepted benefit basis for the diagnosis, mitigation, and treatment of infertility or infertility-related reproductive health conditions provided by medical professionals authorized under applicable law. Participants generally would not be required to enroll in the employer's group health plan coverage in order to enroll in limited excepted benefit fertility coverage."  MORE >>

"Under the proposal, fertility benefits will qualify as excepted benefits under the limited excepted benefit category if they meet the following four requirements (described below in more detail): Coverage must be limited to fertility benefits Benefits cannot exceed the applicable lifetime dollar limit The fertility benefits cannot be an integral part of the plan Participants and beneficiaries must be provided a written notice that describes the coverage"  MORE >>

"Oregon Potato claims that Marsh violated [ERISA] by using a consulting firm ... to manage the company's health plan.... According to [the lawsuit, the defendants] recommended in 2023 that the company switch from a fully insured health plan to a guaranteed level-funded premium plan. The arrangement allegedly enabled [the consulting firm] to collect excessive fees and disadvantaged plan participants, who failed to receive medical benefits for the guaranteed premiums they paid." [Oregon Potato Co. v. Strong, No. 25-5139 (E.D. Wash. Mar. 2, 2026)]  MORE >>

"For many employers, there's no clear fix to the spending surge. Traditional plan options to lower expenses have netted only limited benefits. High-deductible health plans push the cost to the employee; wellness programs have low uptake and little data supporting their efficacy; value-based care is difficult to implement; and pharmacy costs continue to rise even with the growth of transparent pharmacy benefit managers (PBMs).... The challenge is implementing changes that fit into the employer's culture so that employees embrace the new approach."  MORE >>

"Section 419 plans, marketed as legitimate tax deduction vehicles funded by whole life insurance, have been classified by the IRS as abusive tax shelters and consistently rejected by the courts. Plan sponsors face a 100% excise tax on disqualifying dispositions, leaving few legitimate exit strategies for those stuck with large insurance policies held in trust. Transferring plan sponsorship to a related entity that is then sold to a third party with legitimate welfare plan expenses may be the most viable option, though professional guidance is essential."  MORE >>

"Changes to essential health benefits standards: more defrayal by states and no more adult dental services ... Some states could get surprise bill for benefits defrayal ... Pausing review of state EHB benchmark plan applications ... Prohibiting the coverage of adult dental services as EHB ... Deferring to states on network adequacy and essential community providers ... Allowing non-network plans."  MORE >>

10 pages. "Simply matching prior fully insured premiums rarely reflects the true cost structure of a self- funded plan. Claims volatility introduces both risk and opportunity. Favorable experience can generate surplus and long-term savings, whereas adverse experience can create short-term funding pressure. Establishing an appropriate funding margin and surplus policy helps stabilize results and ensure the plan's financial sustainability across multiple years."  MORE >>

"Federal courts are seeing a new wave of Employee Retirement Income Security Act (ERISA) suits based on university health plans that allegedly directed plan participants toward university-affiliated providers without appropriate transparency. Current litigation is pending involving Northwestern University and the University of Rochester, both of which utilize tiered network arrangements. According to the plaintiffs' claims, these arrangements result in much higher costs for plan participants who seek care outside the preferred affiliated network."  MORE >>

"Based on large-employer survey data, 79% were surprised by rate increases, and 94% have experimented with alternative cost-containment approaches. Brokers have said average savings for clients that switch to ICHRAs are 15.5%, but the cost savings may not be the only argument."  MORE >>

"Congress' decision late last year not to extend enhanced marketplace tax credits has boosted the appeal of alternatives to comprehensive insurance ... Unlike plans sold on the exchanges, these options -- some sold by major insurers, others by small companies or nonprofits -- can deny claims with few or no legal rights for consumers to appeal. The plans are not required to cover 'essential health benefits,' such as preventive care, and can impose annual or lifetime caps on benefits. There is debate over whether these options help or harm patients."  MORE >>

"If finalized, the proposed rule would provide a compliant path for employers that desire to offer fertility benefits to their employees on a carve-out basis.... The Departments have expressly requested input on whether the rule should take immediate effect (rather than a January 1, 2027, effective date), the amount of the lifetime limit, whether the limit should instead be an annual limit, and other comments or data that may provide insight into potential fertility benefit plan design and utilization."  MORE >>

"Employment-based health coverage remained the dominant source of health insurance for privately insured adults, with six in 10 receiving coverage through their own job. Coverage patterns have been largely stable, with about one-third enrolled in individual-only coverage and most others covering a spouse or partner.... More than three-quarters of enrollees had a deductible for medical care, including 70 percent of traditional plan enrollees. "  MORE >>

"56% of brokers are now recommending the program as an option. The number of brokers who said they moved at least one client to an ICHRA plan reached 37% in 2026, increasing from 15% in 2024."  MORE >>

"The Education and Workforce Committee passed [bills on May 21 which would] ... increase health care transparency, lower prescription drug costs, and strengthen retirement security.... [1] Form 5500 Filing Simplification Act [HR 7362] ... cuts unnecessary paperwork for retirement and employee benefit plans by simplifying federal reporting requirements and updating filing rules. [2] PBM Kickback Prohibition Act [HR 7895] cracks down on PBM kickbacks and helps ensure health plan design decisions are made in the best interest of patients and employers -- not corporate middlemen. [3] Transparency in Billing Act of 2026 [HR 8684] ... increases transparency for workers and families by requiring hospitals to bill honestly about where services are being provided."  MORE >>

106 pages. "[This report] provides an in-depth view of employers' organizational concerns, business practices, and health, welfare, and retirement benefit offerings. The report compares employer perceptions versus worker realities, and it breaks down survey findings by company size. It also discusses best practices and outlines recommendations for employers."  MORE >>

"ICHRAs and QSEHRAs both allow employers to reimburse employees tax-free for individual health insurance premiums and qualifying medical expenses. Both are employer-funded (as HRAs are required to be), neither requires a traditional group health plan, and both share a common lineage in the broader HRA regulatory framework. But the similarities largely end there. The two arrangements differ materially in employer eligibility, contribution flexibility, employee coverage requirements, ACA interactions, and reporting obligations. These distinctions are important for employers to consider in evaluating either of these options."  MORE >>

"​When adding coverage for weight and obesity care, consider how a long-term, adaptive model can deliver consistent clinical outcomes while maintaining financial predictability. For example, a framework that includes GLP-1 coverage for weight loss should be integrated with a broader, whole-person care model that combines medication with a proven behavioral and lifestyle program, clinical oversight and care coordination."  MORE >>

"Health FSAs must provide 'uniform coverage,' the Section 125 nondiscrimination rules require employers to provide a 'uniform election' with respect to contributions, and employers must implement cafeteria plan elections on a 'uniform interval'."  MORE >>

"Federal agencies released a proposed rule that provides a framework for employers to offer fertility benefits as a HIPAA excepted benefit, allowing broader access to coverage through mechanisms such as a self-funded health reimbursement arrangement. The new pathway contains several requirements, including a lifetime maximum of $120,000 (indexed), and a notice obligation, along with other requirements related to the benefit offering structure. If finalized as written, the rule would become effective for plan years beginning on or after Jan. 1, 2027. Federal agencies will take public comments until July 13, 2026."  MORE >>

"A common assumption is that interns can simply be excluded from health plan eligibility.... For applicable large employers (ALEs), missteps in classifying these workers can create meaningful exposure to employer shared responsibility penalties (ESRP) under the ACA. [This article provides] a closer look at how ACA rules intersect with summer internship programs -- and a few practical steps to help keep your approach on solid ground."  MORE >>

"Over the past two and a half years, nearly 60 lawsuits have been filed alleging that employer-sponsored group health plan tobacco surcharge programs violate the HIPAA and [ACA] wellness program requirements, as well as ERISA's fiduciary standards. While the outcomes of these cases have varied, the HIPAA/ACA wellness regulations remain in effect and should be complied with for an employer-sponsored group health plan that imposes a tobacco surcharge."  MORE >>