"FinCEN's Advisory provides financial institutions with an overview of how fraudsters, organized crime groups, and increasingly, transnational criminal organizations are targeting government health care benefit programs. It also highlights money laundering typologies and red flag indicators to help financial institutions identify and report suspicious activity. Today's Advisory strongly encourages financial institutions to voluntarily report suspicious activity to FinCEN and immediately notify law enforcement of such activity."  MORE >>

"[This case] is a reminder that Hartford's own administrative communications can and will be held against it. When an insurer tells a claimant in writing that administrative remedies are exhausted, it cannot resurrect that argument as a litigation defense. The case also illustrates the tension between ERISA's Section 1132(a)(3) catchall and Section 1132(a)(1)(B) benefits claims -- the court's dismissal of Count I on both limitations and duplicativeness grounds underscores the importance of pleading those claims carefully and timely." [Sakwa v. Hartford Life and Accident Ins. Co., No. 25-4546 (N.D. Ill. Mar. 25, 2026)]  MORE >>

"This decision highlights two practical risks for disability claimants navigating multiple benefit streams. First, a long-term disability insurer's failure to apply an offset -- even for years -- does not necessarily constitute a waiver or a new determination that the claimant can challenge.... Second, claimants who receive more than one Social Security benefit should carefully review their LTD policy's offset language and their insurer's benefit calculations at the outset." [Harling v. Hartford Life and Accident Ins. Co., No. 24-1237 (N.D. Ala. Mar. 26, 2026)]  MORE >>

"Employees that underutilize preventive health care in the present may inadvertently drive higher costs in the future. ... [E]mployees can be guided on how to use their benefits more effectively....  Medical spend for members with chronic conditions has decreased 1.1% YoY, while prescription spend increased 10.6%."  MORE >>

"The traditional employer health benefits model ... optimized for standardization and scale and therapeutic breakthroughs that arrived gradually. But the pace of pharmaceutical innovation has accelerated, the competitive landscape is clear and consumer demand has reshaped how employers respond to breakthrough medications that can shift a plan's entire cost profile within a single year. That's the environment that HR and benefits leaders are managing."  MORE >>

"Amid heightened scrutiny of the pharmacy benefit manager (PBM) model, one health system is touting an alternative approach.... The perceived absence of transparency in the PBM industry, especially among the leading companies in the space, has driven increasing criticism from policymakers and healthcare stakeholders."  MORE >>

"The success of any regulation depends on its details. Policymakers must move from the abstract to the concrete when they strive to implement a policy goal, such as lowering prices for health care services in the commercial market. This requires them to address a series of issues ranging from whether pro-competitive strategies can substitute for a regulatory approach and, if price regulation is implemented, how it should be structured. [The authors] discuss ten issues that policy makers must confront."  MORE >>

"The potential for a lower AV Bronze plan introduces additional uncertainty into the individual market. Individual regulators will need to make decisions on these new flexibilities. Issuers need to consider the risks of pricing these plans too low, as well as whether their competitors do the same. It is also important to note that these plans are occurring alongside other potential low- price plans, including expanded catastrophic plans and non-network plans."  MORE >>

"EBSA's explicit focus on removing barriers to mental health and substance use disorder benefits and on surprise billing, together with added emphasis on cybersecurity and selected plan investment conflict areas, makes clear that plan sponsors and service providers should be prepared for a DOL investigation in these areas.... [T]here are several practical considerations for plan sponsors and service providers that can make an investigation quicker and less painful."  MORE >>