"The Massachusetts Health Connector has published 2026 dollar limits on deductibles and other cost sharing for minimum creditable coverage (MCC) ... For 2026 plan years, Bulletin 01-25 increases the maximum MCC deductibles from 2025 levels: ... MCC rules set the OOPM to match federal ACA limits, which increased from 2025 levels: ... Other types of plans may qualify as MCC without meeting all the monetary standards "  MORE >>

"Having failed to get past a motion to dismiss, the plaintiff in a case alleging a fiduciary breach in health plan administration has modified their arguments -- and brought in another plaintiff to the case." [Lewandowski v. Johnson & Johnson, No. 24-0671 (D.N.J. amended complaint filed Mar. 10, 2025)]  MORE >>

"[A] California resident was denied [AD&D] benefits under his employer's benefits plan, managed by Guardian Life Insurance Company and governed by [ERISA] ... This plan contained two critical clauses: a choice-of-law provision designating Florida law, and a discretionary clause granting the plan administrator broad authority to interpret plan terms. California Insurance Code Section 10110.6 prohibits discretionary clauses in insurance policies; Florida has no such discretionary ban." [White v. Guardian Life Ins. Co., No. 22-1788 (S.D. Calif. Apr. 15, 2024; on appeal to 9th Cir. No. 24-2681)]  MORE >>

"Give employees access to the right resources and tools that can help them set realistic, sustainable goals.... By encouraging employees to break large goals into smaller, more manageable steps, you can help them recognize and celebrate accomplishments along the way.  ... Make sure your workplace's environment isn't an accidental detriment to employee well-being.... Make health improvement part of your workplace culture by talking about your challenges and what you do to recalibrate when you get stuck."  MORE >>

"In the 1960s, when U.S. insurers began integrating prescription drug coverage into their plans, PBMs emerged to help set reimbursement rates, process claims, and pay pharmacies. Since then, PBMs have become increasingly complex organizations with many lines of business, such as specialty and mail-order pharmacy services and group purchasing.... Because of the significant behind-the-scenes impact they have on the total amount insurers pay, how much pharmacies are paid, and which drugs are available to patients, PBMs have faced growing scrutiny about their role in rising prescription drug costs and spending."  MORE >>

"[T]he first year of the pandemic was historic not only for COVID, but for a surprising side effect -- the health system known for inexorable growth actually provided less care in most categories.... Health insurers were huge financial beneficiaries of this surprise. Their profits increased 52% as they continued collecting insurance premiums while fewer patients went to the doctor.... Fast forward past the end of the pandemic, and the health care finance story has changed dramatically -- premiums are rising much faster now, amid a health care cost surge that includes costly new GLP-1 medications for diabetes and weight loss."  MORE >>

"This article explains why health care payers are implementing copay accumulator and maximizer programs and how these programs affect patient care and the broader health system. [The authors] also examine ongoing legislative and regulatory developments at both state and federal levels, offering insights for health care decision makers as they prepare for impending regulatory guidance."  MORE >>

"JPMorgan Chase -- the financial giant that wants to manage your money, your retirement, your future -- stood by as its own consultants, PBM, and HR department let employees pay up to 56,000% more for life-saving medications.... The actual numbers make this case impossible to ignore." [Stern v. JPMorgan Chase & Co., No. 25-2097 (S.D.N.Y. complaint filed Mar. 13, 2025  MORE >>

"The Department cannot require the plan document to obligate a plan sponsor to comply with HIPAA's security rule and adopt the proposed security requirements.... The Department underestimates the feasibility of compliance, along with the upfront and ongoing costs."  MORE >>

"Establishing a committee to which fiduciary duties are delegated is itself a fiduciary act, and the manner in which that act is carried out is subject to the fiduciary standards of ERISA. So, having interposed a layer of protection against fiduciary liability in the form of the fiduciary committee, how can the board fulfill its obligation to monitor the activities of the committee?"  MORE >>

"With a return to office mandate, employees are looking for reasons as to why being physically in the office can benefit them. Simply changing work location can work against an employee who now must navigate logistics related to childcare, household tasks, or commuting costs. So how can companies make the physical office space more appealing?"  MORE >>