"The purpose of the application is to request authorization to participate in electronic filing of the [ACA] Information Returns. The application currently supports the following: [1] Form 1094-B, Transmittal of Health Coverage Information Returns; [2] Form 1095-B, Health Insurance Coverage; [3] Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns; [4] Form 1095-C, Employer-Provided Health Insurance Offer and Coverage. Complete the online ACA Application for TCC if your firm or organization meets the definition of any of the following roles: [1] Issuer ... [2] Transmitter ... [3] Software Developer[.]"  MORE >>

"[T]he HHS Notice of Benefit and Payment Parameters ... establishes the indexed out-of-pocket maximum limits that apply to non-grandfathered group health plans beginning on or after January 1, 2027. Group health plan sponsors should evaluate these updated limits when finalizing plan designs for 2027, specifically regarding whether to increase out-of-pocket maximums or leave them unchanged."  MORE >>

"Tucked within the Consolidated Appropriations Act, 2026 (HR 7148), signed on February 3, 2026, are structural mandates that will reshape Pharmacy Benefit Manager (PBM) operations in Medicare Part D and the commercial sector by 2028. The legislation targets three primary pillars: revenue delinking, rebate transparency, and pharmacy network equity."  MORE >>

"A group health plan is required to establish a database on its public website that contains a list with directory information for each health care provider and facility with which it has a direct or indirect contractual relationship for furnishing items and services.... [A] plan must establish a process to verify and update, at least once every 90 days, the information included in the website database."  MORE >>

"In the latest installment of a long-running dispute, a federal trial court has again prohibited a large insurer from using internal claim guidelines that were inconsistent with generally accepted standards of care (GASC) for the treatment of mental health and substance use disorders.... The trial court has now revised its decision, holding that the plans did not require the insurer to approve benefits for all services that were consistent with GASC but did require, as a condition of coverage, that services be consistent with GASC.... Thus, the willful and systematic use of the guidelines violated ERISA's duty of loyalty and care toward the participants ... The court permanently barred the insurer from using the flawed guidelines for ERISA-governed plans and will retain jurisdiction for five years, during which any guidelines adopted by the insurer must accurately reflect GASC and any applicable state law." [Wit v. United Behavioral Health, No. 14-2346 (N.D. Calif. Feb. 3, 2026)]  MORE >>

"Despite the many unknowns ... these lawsuits will: [1] Provide in-depth briefing on core ERISA foundational questions.... [2] Push the boundaries of fiduciary duties and prohibited transaction rules under ERISA.... [3] Create a chilling effect on employers offering voluntary benefits."  MORE >>

"Claims data, eligibility files, engagement metrics, clinical insights, and behavioral signals fuel AI tools that promise efficiency, personalization, and cost optimization.... [M]ost employers don't actually know where their data is going, or how it's being used once it gets there. That blind spot is becoming a bigger risk."  MORE >>

"The most effective time to secure strong data access rights is when negotiating a new contract, more specifically during a request for proposal (RFP) or similar competitive process. When multiple TPAs or PBMs are competing for your business, the balance of power shifts. Even incumbents who previously claimed their 'hands were tied' often become far more flexible once they know another vendor could win the contract. Competition matters -- and it works."  MORE >>

"One of the most thorough analyses of the quality of hospital and health plan price transparency data got little attention when it was published last fall.... [T]he 185-page report from the Purchaser Business Group on Health (PBGH) ... shows the problems employers face when contracting with health insurers and hospitals for workers' health coverage."  MORE >>

"Among specialties likely to be affected by the No Surprises Act protections -- emergency medicine, radiology, anesthesiology, and air ambulance -- the percentage of in-network claims increased for three of the four specialties after the act took effect.... Payment changes for the selected services largely reflected continuations of trends prior to the No Surprises Act taking effect." [GAO-107169 Feb. 19, 2026]  MORE >>