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Health & Welfare Plans Newsletter

April 10, 2026

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💼  3 New Job Opportunities

 

[Official Guidance]

Text of CMS Final Regs: Contract Year 2027 and Certain Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program

"[S]ection 1860D-13(b)(6)(B)(i) of the [Social Security Act] requires that 'entities that offer prescription drug coverage' must provide creditable coverage disclosures.... [CMS proposes] to revise Section 423.56(b)(3) so that account-based entities are not required to provide the creditable coverage disclosures.... [R]equiring account-based plans, such as HRAs, including ICHRAs, to determine if their coverage is creditable, and requiring them to report the creditable status of that coverage, unduly increases administrative burden on these entities ... After consideration of the comments received on this provision by a broad range of stakeholders, we are finalizing this policy as proposed without modification. "  MORE >>

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Official Guidance]

Text of CMS Bulletin: Revised Timing of QHP Data Submission and Certification for the 2027 Plan Year for Issuers in the Federally-Facilitated Exchanges (PDF)

"[CMS] s releasing this bulletin establishing the submission deadlines under 45 CFR 155 subpart K for health insurance issuers applying to offer qualified health plans (QHPs) on the Federally-facilitated Exchanges (FFEs).... Table 1 lists key PY2027 dates for QHP certification applications and related data submissions. Additional information about the PY2027 QHP certification process will be provided in future guidance."  MORE >>

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

CMS Exempts HRAs from Part D Creditable Coverage Reporting

"[U]nder the prior notice requirements, individuals could receive contradictory notices -- such as a non-creditable coverage notice from an HRA and a creditable coverage notice from a prescription drug plan -- leading to confusion about whether individuals were actually enrolled in creditable coverage. The Final Rule recognizes the difficulty in comparing the value of an HRA to the actuarial value of prescription drug coverage."  MORE >>

Groom Law Group

[Guidance Overview]

FTC Settlement With ESI, CAA 2026, and Proposed Rule: What Does It Mean for Plan Sponsors?

"The ESI settlement creates new options for plan sponsors, but few protections apply automatically without proactive action. With the CAA 2026, transparency is expanding meaningfully, but important PBM revenue streams remain partially hidden. The DOL's Proposed Rule increases fiduciary accountability by tying PBM compensation transparency directly to ERISA oversight. Turning transparency into value will require active governance and independent pharmacy benefit expertise."  MORE >>

EPIC

[Guidance Overview]

Updates to New York City Earned Safe and Sick Time Act

"[C]ertain changes to the New York City Earned Safe and Sick Time Act (ESSTA) went into effect on February 22, 2026.... [A]dditional Rules and FAQs have been published offering further developments and guidance ... [1] Notice of Employee Rights ... [2] Determining size of employer ... [3] Change in employer size ... [4] Employers located outside New York City must provide protected time off to employees who work in New York City.... [5] Broad interpretation of 'family member' ... [6] Advance notice from employee ... [7] Documentation ... [8] Discipline."  MORE >>

Herrick, Feinstein LLP

The Price Is Wrong: Dominated PPOs and the Downfall of ERISA Settlor Discretion

"[T]he court held that participants who received every promised benefit could still demonstrate injury in fact under Thole... by alleging they paid too much for that coverage. Second, the court declined to resolve the settlor doctrine defense at the motion to dismiss stage, holding that whether Northwestern's decisions regarding the design of coverage options constitute fiduciary or settlor functions is a 'fact-intensive' inquiry better suited for summary judgment." [Barbich v. Northwestern Univ., No. 25-6849 (N.D. Ill. Apr. 2, 2026)]   MORE >>

Vorys

A Landmark Shift in Healthcare: Insights on PBM Reform

"New laws and court decisions, settlements with the Federal Trade Commission, and a proposed [DOL] rule are leading to a sweeping transformation that is already under way in the U.S. healthcare system. Pharmacy benefit managers (PBMs) are now facing the same transparency and accountability requirements that employers and health plans are subject to.... [T]hese changes could fundamentally reshape how PBMs, employers, pharmacies and insurers manage prescription drug costs."  MORE >>

Managed Healthcare

Short-Term Disability vs. FMLA: Key Differences

"Short-term disability (STD) provides income replacement when you cannot work. The Family and Medical Leave Act (FMLA) provides job protection. These benefits serve different purposes, follow different eligibility rules, and fall under different laws. Understanding how they work together matters."  MORE >>

DeBofsky Law

Benefits in General

[Official Guidance]

IRS Disaster Relief Notice TN-2026-01, for Taxpayers Impacted by Winter Storm Fern in Tennessee

"[I]ndividuals and businesses in Tennessee affected by Winter Storm Fern that began on Jan. 22, 2026 ... now have until May 22, 2026, to file various federal individual and business tax returns and make tax payments.... [I]ndividuals and households that reside or have a business in Cheatham, Chester, Clay, Davidson, Decatur, Dickson, Hardeman, Hardin, Henderson, Hickman, Lawrence, Lewis, Macon, Maury, McNairy, Perry, Robertson, Rutherford, Summer, Trousdale, Wayne, Williamson and Wilson counties qualify for tax relief."  MORE >>

Internal Revenue Service [IRS]

Closing the AI Readiness Gap in Employee Benefits

"71% of benefits teams report limited or no access to internal AI skills and resources, even when enterprise AI capabilities exist elsewhere. Risk concerns are most acute where financial and fiduciary exposure is highest, including data privacy, AI errors and compliance risk. Only 1% of employers report having a fully developed AI roadmap or governance framework specific to benefits. This creates a fundamental challenge: expectations for rapid acceleration are rising faster than the foundations required to scale."  MORE >>

WTW

White House Proposes Cuts in DOL, IRS Budgets for FY '27

"The White House requested a discretionary budget of $9.9 billion for the DOL as a whole. The DOL enacted budget for 2026 was $13.7 billion.... [EBSA] would receive $181.1 million in funding, a cut of $10 million from 2026 enacted levels, and the same as the requested level from last year by the White House.... The IRS requested $9.8 billion in funding, a cut of $1.4 billion from the enacted level for 2026. The White House blueprint adds that ... agency staffing was reduced by 27%."  MORE >>

American Retirement Association [ARA]

Employee Benefits Jobs

💼

Plan Admin/Employee Benefits/Office Admin

Columbia Benefits, LLC

Remote / Denver CO

View job as Plan Admin/Employee Benefits/Office Admin for Columbia Benefits, LLC

💼

Senior Plan Consultant, Defined Benefit

DWC - The 401(k) Experts

Remote

View job as Senior Plan Consultant, Defined Benefit for DWC - The 401(k) Experts

💼

Paralegal - ERISA/Employee Benefits

Hill Ward Henderson

Tampa FL

View job as Paralegal - ERISA/Employee Benefits for Hill Ward Henderson

Webinars, Podcasts and Conferences
(Health & Welfare Plans)

California Bereavement Leave: It’s Not About Good Intentions

PODCAST

Shaw Law Group

Last Issue's Most Popular Items

NAIC Draft Guidance Document: ERISA Preemption and State PBM Laws (PDF)

ERISA and Alternative Health Coverage (B) Working Group, National Association of Insurance Commissioners [NAIC]

When Is a Dependent Child Considered to Be Age 26 for Purposes of Terminating Group Health Plan Coverage?

Thomson Reuters / EBIA

Example Prompts for Benefits Administration: How to Direct AI Effectively

International Foundation of Employee Benefit Plans [IFEBP]

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BenefitsLink® Health & Welfare Plans Newsletter, ISSN no. 1536-9595.

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