"While group health plan sponsors (plan sponsors) have been grappling with PBM reform laws at the state level, plan sponsors should now be aware of two key developments at the federal level ... [T]hese developments will fundamentally reshape the business and financial practices of PBMs and how plan fiduciaries engage with and monitor their PBMs and other service providers. Both initiatives share a common objective: ensuring that plan sponsors have the information necessary to fulfill their fiduciary duties under ERISA when selecting and monitoring PBMs."  MORE >>

"This article addresses several proposed changes to the regulation and sale of catastrophic plans, ... new policies to implement parts of the OBBBA ... new cost-sharing reduction (CSR) reporting requirements; and old policies that were adopted in last year's marketplace rule but set aside in court (including pre-enrollment SEP verification requirements and income verification requirements)."  MORE >>

"This article addresses the proposed rule's changes to essential health benefits (EHB) requirements, standardized plans, network adequacy, essential community providers (ECPs), and risk adjustment. It also discusses HHS requests for information on premium payment thresholds and medical loss ratio (MLR) standards."  MORE >>

"This article ... addresses the proposed rule's changes to exchange requirements -- including a new option for state-based exchanges (SBEs) to rely on enhanced direct enrollment (EDE) -- and new oversight standards for insurers as well as agents and brokers."  MORE >>

"[T]he Central District of California enforced a Massachusetts choice-of-law provision in an ERISA long-term disability policy and held that abuse-of-discretion review applies to the insurer's denial of benefits. The decision squarely addresses the increasingly litigated intersection between contractual governing-law clauses and California Insurance Code Section 10110.6, which voids discretionary clauses in disability policies covering California residents." [Hildebrandt v. Unum Life Ins. Co. of Am., No. 23-2297 (C.D. Cal. Feb. 13, 2026)]  MORE >>

"[A]mid low compliance and other struggles in implementing the policy since it took effect in 2021, the available price data is sparse and often confusing. And instead of patients shopping for medical services, it's mostly health systems and insurers using the little data there is, turning it into fodder for negotiations that determine what medical professionals and facilities get paid for what services."  MORE >>

"For plan sponsors, this evolving litigation environment is an important reminder that understanding fiduciary risk -- and taking proactive steps to manage it -- is no longer optional.... The central argument being tested is that when an employer selects voluntary benefit programs, endorses them, and receives additional services from brokers that may be considered compensation, the employer may be exercising sufficient control for those benefits to be considered ERISA-covered plans, or at minimum subject to fiduciary standards."  MORE >>

"HSAs are increasingly operating like powerful long-term investment vehicles rather than just spending accounts. Yet misconceptions persist across the workforce, and employee education continues to lag.... [This article examines] the triple tax advantages, workforce perception trends, and evidence-based insights to guide employers in maximizing HSA participation and value."  MORE >>