"Employers should prepare now for significant changes to group health plan requirements starting in 2026. Updated HRSA Women's Preventive Services Guidelines will expand the scope of breast cancer screening benefits and add new navigation services that must be provided at no cost to plan participants."  MORE >>

"AI-enabled tools promise improved efficiency, cost savings, better clinical outcomes, and streamlined administrative processes. Yet, their adoption in group health plans raises complex regulatory, fiduciary, and ethical questions, particularly under [ERISA] ... [I]ssues that require immediate attention by plan sponsors and plan administrators alike: claims adjudication, fiduciary oversight, and vendor contracts."  MORE >>

"Self-funded employers are expected to retain flexibility to cover the COVID-19 vaccines at no cost to members. Health plans and pharmacy benefit managers are awaiting confirmation. Fully insured employers, on the other hand, may face more limitations. ... [as they] are subject to the carrier's interpretation of federal and state guidance. If the vaccine is not broadly recommended for healthy individuals under 65, carriers may limit coverage to only those with a medical indication or a provider's prescription."  MORE >>

"Distribute weekly emails that highlight different key topics such as expected plan changes, new carriers and changes in contributions.... Short videos can explain complex topics such as deductibles and HSAs. Infographics can demonstrate how your benefit offerings complement each other.  ... As open enrollment draws near, offer employees access to insurance experts who can answer questions and help them apply their benefits knowledge to real life scenarios."  MORE >>

"Cost containment remains the top concern ... Benefits strategy is now a year-round exercise ... Employees need fewer choices -- and better guidance."  MORE >>

"Despite the virtues and benefits of primary care, it seems to be getting harder to access. In 2025, there were 7,901 primary care health professional shortage areas. A recent report found that primary care physicians per capita declined between 2012 and 2021, and fewer trainees chose to pursue primary care than specialty care over the same period.... Nationally, among people with ESI, primary care made up 4.39% of total medical and prescription spending in 2022. Primary care spending in Medicare FFS was lower than ESI, at 3.86% of total spending. "  MORE >>

"There are several arbitrations and even lawsuits over the Plan which Morgan has been defending for years. In those cases, the plaintiff-advisors maintain that the Plan is subject to ERISA and violates its minimum vesting rules. Morgan has been winning many arbitrations. However, in July the United States Court of Appeals for the Second Circuit held the Plan was subject to ERISA and the plaintiff's in the class action could go to arbitration with their claims.... The DOL's Advisory Opinion gives Morgan even more ammunition to defend the arbitrations and may even chill future claims." [Shafer v. Morgan Stanley, No. 24-3141 (2d Cir. Jul. 9, 2025).]  MORE >>

"The employer claimed that it had received consent because it had revised its SPD to include the arbitration agreement and to inform participants that their continued participation in the plan would constitute consent to arbitration. The court responded that the SPD the employer sent to participants was 170 pages long." [Platt v. Sodexo, S.A., No. 23-55737 (9th Cir. Aug. 4, 2025)]  MORE >>

"With so many people opting to strike out on their own, ... some professional groups are setting up systems to make it a little easier for the entrepreneurial-minded, offering group health insurance and, in some cases, retirement funds.... Long-time freelancers and contract workers, though, say that while it's nice to have those as a backstop, the smartest thing to do is to find a good financial professional and consult with them first."  MORE >>