"Eligible employees may file an application for benefits within sixty days before the anticipated start date of leave and no later than sixty days after the start date.... Employers have five business days to respond to notice of an employee's submitted claim application.... The final regulations allow for the reduction of FAMLI eligibility by an employee's federal [FMLA] use if the FMLA leave also qualified for FAMLI, the employer notified the employee of their potential FAMLI eligibility, and the employee did not apply."  MORE >>

"[This case] gives self-funded ERISA plan sponsors in the Sixth Circuit helpful guidance on where to draw the line between the permitted state PBM regulations described in Rutledge and ERISA-protected plan design. The Sixth Circuit made clear that a state may not require a self-funded ERISA health plan to open its pharmacy network to any willing pharmacy if doing so takes away the employer's ability to decide which pharmacies will participate." [McKee Foods Corporation v. BFP Inc., No. 25-5416 (6th Cir. Apr. 7, 2026)]  MORE >>

"Magistrate Judge Karen Scott ... dismissed the federal claims Anthem brought against HaloMD, a billing company, and its co-defendants.... [S]he found that the No Surprises Act allows courts to review arbitration decisions only under very narrow circumstances -- corruption, fraud, or misconduct that could not have been discovered during the arbitration itself, such as bribery, undisclosed bias, or willfully destroyed evidence. Anthem, the judge said, had not met that bar." [Anthem Blue Cross v. HaloMD LLC, No. 25-1467 (C.D. Calif. Apr. 9, 2026 )]  MORE >>

"This webpage provides data on how the IDR process is working, including estimates of the average prices emerging from IDR, qualifying payment amounts (QPAs) calculated by health plans, and comparisons of plan and provider offers, all expressed as percentages of Medicare’s payment rates for the same services. It also includes information on the characteristics of the providers and firms using the IDR process."  MORE >>

"Billions of dollars and implications for the business models of insurers and pricing vendors are on the line in litigation against MultiPlan (now known as Claritev) and Zelis, along with their insurer clients. In each case, plaintiff providers say insurers conspired with a pricing intermediary to underpay out-of-network claims by deploying repricing tools or algorithms. Both vendors are alleged to have served as a hub that coordinates prices among insurers that otherwise would compete with one another on price."  MORE >>

"The next evolution of benefits strategy isn't about collecting more data or adopting AI for its own sake. It's about building a deliberate, closed-loop approach that connects insights to action and action to outcomes. In practical terms, this approach helps close the gap between the benefits offered and the benefits used."  MORE >>

"Health Savings Accounts (HSAs) are an attractive target for fraudsters, and HSA providers must use automated methods to stop them before funds are lost....Best practices include: [1] Retiring micro-deposit verification through bank accounts. [2] Integrating instant bank account verification inside the member app. [3] Enabling real-time verification outcomes."  MORE >>

27 pages. "OCR received 732 notifications of breaches of unsecured PHI affecting 500 or more individuals that occurred during 2023, representing an increase of 17% from the number of reports received in calendar year 2022. These reported breaches affected a total of approximately 113,173,613 individuals. The most commonly reported category of breaches was hacking, and the largest breach of this type involved approximately 11,270,000 individuals. OCR also received 68,315 reports of breaches affecting fewer than 500 individuals that occurred during 2023, with unauthorized access or disclosure as the most frequent type of breach reported. These smaller breaches affected a total of 269,290 individuals."  MORE >>

"More than 4 in 5 adults younger than 65 with incomes of 400% or more of the federal poverty level have ESI, compared to 57% with incomes between 200% and 399% of the poverty level and 22.5% with incomes below 200%.... Younger workers are less likely than those in older age groups to have ESI."  MORE >>

"As the cost of health insurance increases, employers continue to grapple with what types of benefits their employees want, how much to spend, and how to share costs with employees. This brief discusses some of these differences, focusing on the costs, availability, and take-up of health benefits for workers with lower wages, and ways employers may respond to the pressures of high costs and limited resources for these workers."  MORE >>

"This article examines the role of co-payments in the context of high-cost, physician-administered, curative therapies and evaluates whether traditional cost-sharing rationales remain applicable. Drawing on emerging evidence from chimeric antigen receptor T-cell therapy utilization, we highlight persistent disparities in access by race, socioeconomic status, geography, and insurance type and discuss how patient cost sharing may exacerbate inequities in a category characterized by strict clinical eligibility, intensive oversight, and minimal risk of inappropriate use."  MORE >>

"One of the most notable aspects of [FAB 2026-01] is that EBSA plans to focus its enforcement efforts on cases that pose meaningful harm to the employee benefits system, especially those involving bad faith conduct.... They have an express focus on breaches of the fiduciary duty of loyalty. However, just as important, the DOL emphasized that ERISA is a 'law of process, not results.' ... [T]he agency says it generally won't second‑guess fiduciary decisions where a prudent process was followed."  MORE >>

"Secretary of Labor Lori Chavez-DeRemer resigned from her post [April 20].... Deputy Secretary Keith Sonderling will be acting secretary ... The [DOL's] inspector general had been conducting an internal investigation of Chavez-DeRemer since January ... over reported allegations of misconduct."  MORE >>