"The 2026 changes to the Medicare Part D drug benefit passed under the Inflation Reduction Act are generally modest compared to the significant adjustments made in 2025. However, new instructions related to determining the creditable coverage status of prescription drug coverage allow plan sponsors to utilize a revised methodology for 2026. Plan sponsors should review the new methodology as they determine the most suitable one for their particular group health plan."  MORE >>

"Recent headlines have provided ... information on changing approvals of recommended vaccines.... As the group health plan rules continue to evolve, longstanding legal requirements still apply. In particular, group health plan coverage for pediatric vaccines has been mandated to remain constant since May 1, 1993."  MORE >>

"This critical period consistently highlights the many complex rules applicable to employer-sponsored health and welfare plans, and this year brings some new additions due to changes in federal law.... [1] Employer mandate under the [ACA] ... [2] Cafeteria Plans under the Internal Revenue Code ... [3] IRS limits for account-based plans ... [4] Open enrollment rights under COBRA and the FMLA ... [5] Required disclosures under ERISA and other laws."  MORE >>

"Over the past quarter, federal and state actions continued to reshape the legal and compliance landscape for health plans in the areas of abortion and gender-affirming care.... [This article highlights] the most consequential legal shifts and emerging trends that health plan sponsors and employers should be tracking as they navigate an increasingly complex regulatory environment."  MORE >>

"[A] District Court invalidated the [CMS] 2023 RADV Final Rule, finding that the agency violated the notice-and-comment requirements of the Administrative Procedure Act (APA). This ruling comes amidst a recently announced aggressive agenda by the current Trump administration to catch up on five payment years of RADV audits." [Humana Inc. v Becerra, No. 23-0909 (N.D. Tex. Sep. 22, 2025)  MORE >>

"In a healthcare environment where errors, system issues, and coordination of benefit failures are common, relying solely on the administrator's internal processes without independent oversight exposes plan assets and fiduciaries. Overpayments, often caused by misapplication of contracts, duplicate claims, eligibility errors or misapplied benefits, can quietly drain plan assets if not actively monitored."  MORE >>

"As prescription drug costs have generally outpaced inflation, PBMs have become a common target of state legislators ... [S]ome laws impose a specific standard of conduct on PBMs working on behalf of both fully insured and self-funded ERISA plans."  MORE >>

"[1] Leverage data analytics for early identification ... [2] Implement robust care management programs ... [3] Adopt a Centers of Excellence (COE) strategy ... [4] Optimize pharmacy benefit management ... [5] Incorporate stop-loss insurance with data-driven underwriting ... [6] Promote employee engagement and health literacy ... [7] Review and update plan design regularly ... [8] Coordinate with point solutions -- but avoid fragmentation."  MORE >>

"With family health insurance premiums ... now averaging more than $25,000 per year, and deductibles climbing nearly 50% in the last decade, many households are feeling the pinch.... Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) are valuable tools that not only help manage day-to-day medical costs but can also play a strategic role in your broader financial plan."  MORE >>

"Employers have long believed they had already “cost-shifted” as much as possible through higher premiums, copays and deductibles. But with costs reaching historic levels, that thinking is changing. Employers are rethinking their strategies and placing renewed emphasis on shared responsibility by asking employees to play a more active role in both managing expenses and improving health outcomes."  MORE >>

"Increases in non-claims payments are often seen as a positive sign. They suggest a shift away from fee-for-service payments toward alternative payment methods (APMs) -- value-based payment models that incentivize care coordination, efficiency, and a focus on outcomes. However, it's unclear what is included in these non-claims payments. A closer examination of this issue revealed a less visible but important concern: the role of insurer-provider vertical integration in potentially weakening the effectiveness of Medical Loss Ratio (MLR) requirements for insurers."  MORE >>

"A comprehensive benefits administration solution will typically offer more value than general HCM software, in terms of robust employee experience and end-to-end service and support. This article will uncover some of the hidden value of a comprehensive benefits administration solution, as well as additional costs you may encounter with general HCM software."  MORE >>