"Historically, fiduciary breach lawsuits in the benefits space have focused on excessive fees and vendor mismanagement. This case, however, raises a new legal question: Does the knowledge of better cost-saving strategies -- and failure to act -- constitute a fiduciary breach? If courts embrace this line of reasoning, it could significantly raise the stakes for health plan sponsors." [Stern v. JPMorgan Chase & Co., No. 25-2097 (S.D.N.Y. complaint filed Mar. 13, 2025)]  MORE >>

"With the recent filing of the complaint against JPMorgan, the J&J case is now one of three putative class actions ... where current or former plan participants have alleged that employers mismanaged their self-funded health plans' prescription drug benefit. The J&J case may be a test case for a potential wave of additional putative class actions by health plan participants against employers based on alleged mismanagement of health plan fees and expenses." [Lewandowski v. Johnson & Johnson, No. 24-0671 (D.N.J. amended complaint filed Mar. 10, 2025); Stern v. JPMorgan Chase & Co., No. 25-2097 (S.D.N.Y. complaint filed Mar. 13, 2025)]  MORE >>

"Spending growth for traditional drugs -- simple-to-administer medications used to treat common health problems -- outstripped spending growth for specialty drugs -- pricey medications used to treat complex and chronic conditions -- for the first time in 2023 ... Coverage of GLP-1s for weight loss has steadily increased, though it's not universal.... 59% of health plans and 22% of employers report they cover GLP-1s for weight loss."  MORE >>

"States are beginning to regulate the use of AI as a patient care support tool, for both healthcare payers and providers.... At the same time, private class action litigation and state attorneys general are challenging AI practices in the healthcare sector.... In this climate, governing boards should ensure that these evolving state law developments are being monitored and, as applicable, adjustments to operations are made."  MORE >>

"American insurers are being urged not to drag their feet on ensuring their use of AI is 'explainable,' as regulators and consumers alike begin to demand it.... Explainable AI (XAI) is about the clarity of the reasoning of how an AI tool makes a decision. It can refer both to an actual AI system, or a larger concept of AI technology designed in a way for its logic to be easily understood by humans."  MORE >>

75 pages. "The ACA's access chassis has continued to drive Increased coverage through both the Medicaid program and the individual market, resulting in a significantly reduced uninsured rate.... After two years of corrective rate action in 2017 and 2018, average ACA premium rates have remained remarkably stable for the past six years, with average annual premium rate increases that trail consumer price inflation.... Faced with substitute product offerings, declining enrollment, and increasing morbidity, the fully insured Small Group Market has not flourished under the ACA and faces higher prices and decreasing relevance."  MORE >>

"[M]any organizations focus heavily on traditional big-ticket benefits like premium healthcare plans while missing opportunities to create greater value through strategically allocating their benefits budget. The concept of WAR in employee benefits asks a simple but powerful question: How much additional value does a specific benefit provide compared to standard market offerings? This framework helps organizations move beyond the traditional emphasis on actuarial value to consider the total impact of their benefits strategy on employee attraction, retention and satisfaction."  MORE >>

"This guide provides a high-level reference resource, in a plan-by-plan format, on how to approach each type of compensation or benefit arrangement when an employee dies, and offers up some practical tips on employee benefits issues that may come up as you manage your company’s compensation and benefit administration for a deceased employee."  MORE >>