"A notable change in the proposed revision includes expanding the scope to acknowledge that the performance of actuarial services for retiree group benefit programs may require actuaries from more than one practice area, in which case, all references to actuary collectively apply to collaborating actuaries, and to clarify the application of the standard when the actuary selects an output smoothing method and when an assumption or method is not selected by the actuary."  MORE >>

"The proposed regulations reflect the DOL's position that group health plan fiduciaries have a duty to ensure the reasonableness of fees and that transparent fee disclosures should help them to evaluate PBM arrangements. ... [T]he DOL recognizes that negotiating PBM arrangements requires specialized expertise, and that most group health plans must work with benefits consultants or brokers who may have conflicts of interest due to payments or rebates they receive from PBMs. The proposed regulations ... do not provide guidance on how fiduciaries can use [the disclosures] to negotiate more favorable prescription drug prices."  MORE >>

"[T]he Proposed Rule would: [1] Allow issuers to offer catastrophic plans with terms of either one year or multiple consecutive years, up to 10 years ... [2] Repeal standardized plan options and related limit requirements ... [3] Permit low-deductible plans with higher maximum out-of-pocket limits ... The Proposed Rule also adds additional standards of conduct for insurance agents, brokers, and web-brokers 'by clarifying prohibited marketing practices and reinforcing oversight to deter fraud and misleading conduct.' "  MORE >>

"The maximum annual limitation on cost sharing that a group health plan can impose on essential health benefits has been increased by 13.2% for 2027."  MORE >>

"New York City's Earned Safe and Sick Time Act (ESSTA) adds 32 hours of frontloaded unpaid safe/sick time to its existing paid safe/sick time requirements for employers. The ESSTA also expands the permissible uses for both types of leave under the Act to include scenarios tied to caregiving, housing or subsistence proceedings, public disasters and workplace violence. Employers ... will no longer be required to grant a set number of temporary schedule changes; employees, instead, will enjoy a protected right to request such changes."  MORE >>

"The plan clearly required enrollment of a newborn within 31 days of birth for coverage to be effective retroactively to the date of birth, and the participant provided no evidence that such enrollment had occurred. The court further rejected the participant's argument that NMHPA requires automatic coverage for newborns, explaining that the statute only prohibits plans from limiting the length of hospital stays for mothers and covered newborns below the statutory minimum." [Townley v. Aetna Life Ins. Co., No. 24-3513 (S.D. Tex. Dec. 31, 2025)]  MORE >>

"[This decision] reinforces several recurring themes in ERISA litigation: [1] Boilerplate objections remain disfavored and can be deemed waived. [2] Incentive and bonus structures tied to claim outcomes are generally discoverable when limited to personnel involved in the claimant's file. [3] 'Batting average' statistical discovery continues to face significant judicial resistance. [4] Courts will tailor discovery to the handling of the specific claim at issue, rejecting sweeping company-wide requests." [Schaefer v. Unum Life Ins. Co. of Am., No. 24-0590 (M.D. Penn. Feb. 12, 2026)]  MORE >>

"Executive benefits are an increasingly common way for employers to attract and retain top talent for key positions in the organization. Although nondiscrimination rules often present barriers to implementing certain forms of executive arrangements, there are almost always workarounds, alternatives, or taxable (with a gross-up if desired) approaches that can accomplish many of the same goals."  MORE >>

"In 2018, 7.9 per 100,000 enrollees received a CGT; by 2022, the rate rose to 9.2 per 100,000.... CGT users represent fewer than one-tenth of one percent of the enrollee population but account for approximately one-half of one percent of total spending.... Among enrollees in the top 1 percent of total health care spenders, just 0.58 percent used CGTs. However, these individuals accounted for 1.6 percent of spending within that top-spending group."  MORE >>