"The final rule codifies that account-based medical plans, specifically HRAs and ICHRAs, are no longer required to determine, document, or disclose their creditable coverage status to Part D-eligible individuals. CMS concluded that the fundamental design of account-based arrangements -- which provide tax-free reimbursements for medical expenses and individual policy premiums rather than comprehensive prescription drug benefits -- makes actuarial comparisons to the Medicare standard drug benefit inapplicable."  MORE >>

"[A] Ninth Circuit panel ... reversed a Central District of California ruling that had affirmed UnitedHealthcare's denial of health benefits for surgical assistant services, and further found that the district court abused its discretion in denying attorneys' fees and declining to impose statutory penalties under 29 U.S.C. Section 1132(c)(1). The decision ... presents a striking account of insurer stonewalling and a clear application of the Ninth Circuit's meaningful dialogue doctrine." [Campbell v. UnitedHealthcare Insurance Co., Nos. 24-5736, 25-758 (9th Cir. Apr. 13, 2026; unpub.)]  MORE >>

"[S]everal recent federal district court decisions now provide the first substantive rulings on these issues. Notably, each court dismissed the plaintiffs' claims in full, signaling a trend that is generally favorable to employers. That said, this remains an actively litigated area, with dozens of similar lawsuits pending nationwide. Employers should continue to monitor developments and ensure compliance with applicable wellness program rules."  MORE >>

"We are seeing the migration of 401(k)-style fiduciary claims to health plans, accelerated by transparency requirements established by the Consolidated Appropriations Acts of 2021 and 2026. The unifying question is often not whether a single rule was violated, but whether the plan sponsor followed a prudent fiduciary process."  MORE >>

"AI is changing medical imaging by finding cancers earlier and making it easier for doctors to diagnose cancer. Billing inconsistencies and the lack of standardized codes pose problems.... Payment for these advances will be a challenge for employer-sponsored health insurance."  MORE >>

"Advocates provide one‑on‑one support to help employees understand coverage, work through carrier issues, and resolve claims without sending every issue back to HR. By handling routine benefits concerns, advocacy reduces administrative strain, shortens resolution times, and allows HR to focus on higher‑value priorities. At the same time, employees gain clearer guidance and greater confidence when it matters most."  MORE >>

"Starting in 2027, the common procedural terminology (CPT) codes for maternity care will change from a bundled global maternity code to multiple itemized codes reflecting individual services. As a result of this change, group health plans will no longer be billed a bundled payment for maternity care, instead each individual item and service will be billed separately. The coding change may impact plan costs, participant cost-sharing, access, and care."  MORE >>

"Rhode Island ... became the first state to explicitly prohibit menopause discrimination and require workplace accommodations ... A significant gap exists in federal law, leaving employees to rely on overlapping protections (sex, age, disability) ... [M]ore states are likely to follow and menopause-related claims are already gaining traction -- making it important to consider accommodations and policy updates now."  MORE >>

"This white paper examines state reinsurance programs through a financial and actuarial lens.... [The authors] highlight how reinsurance transforms previously unbounded risk into manageable exposure and creates new strategic opportunities for payers ... [and] explore how insurers can leverage these dynamics through condition-specific product strategies and consider the implications of a potentially shrinking ACA market on 1332 waiver funding and the long-term sustainability of reinsurance programs"  MORE >>