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Health & Welfare Plans Newsletter

May 7, 2026

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[Guidance Overview]

What Is the Status of the ACA's Insured Health Plan Nondiscrimination Requirements?

"Although insured group health plans initially were required to comply with the ACA nondiscrimination rules for plan years beginning on or after September 23, 2010, the IRS announced in Notice 2011-1 that compliance is not required until the agencies issue regulations or other guidance regarding how the rules apply to insured plans. To date, the agencies have not issued such regulations or guidance, so sanctions for failure to comply do not yet apply for insured plans."  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

CMS to Provide Low Cost Access to GLP-1 Medications for Medicare Beneficiaries

"[B]eginning July 1, 2026, through December 31, 2027 ... [e]ligible individuals enrolled in Medicare Part D prescription drug plans will be able to access these medications at a predictable and affordable cost -- $50 for a monthly supply."  MORE >>

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

Health Plans Are the Next Fiduciary Litigation Target

"Recent litigation makes clear that ERISA's fiduciary standards apply with full force to group health plans, particularly prescription drug benefits, pharmacy benefit manager (PBM) arrangements, and voluntary benefit offerings.... Beyond litigation defense, a committee structure improves plan operations. Concentrating fiduciary expertise supports more consistent and well‑documented decisions, stronger vendor selection and monitoring, clearer separation between business decisions and fiduciary functions, and enhanced compliance with increasingly complex health plan regulations."  MORE >>

Bricker Graydon Wyatt

AI Reshapes Employer Group Health Plans for Fiduciaries

"ERISA plan fiduciaries remain fully responsible for ensuring that AI is used prudently, loyally, and solely in the interest of plan participants, even when AI is deployed by third-party service providers. Because AI systems function as opaque 'black boxes,' fiduciaries face challenges in monitoring their use. Fiduciaries can mitigate risk through reviewing vendor AI policies, requesting audits, requiring compliance with emerging standards ... and negotiating robust AI-specific contract and request for proposal terms addressing transparency, bias, cybersecurity, compliance, and accountability."  MORE >>

Best Best & Krieger LLP in Bloomberg Tax

Why Payers Must Lead the Charge for Better Employer-Sponsored Healthcare

"More than 80% of employers believe meaningful healthcare system modernization is achievable within the next few years. Employers are already benefiting from improved tools, processes, and support, while payers continue to face operational complexity -- a gap that signals opportunity for innovation and partnership."  MORE >>

Employee Benefit News [EBN]; login required

Leveraging Transparency in Coverage (Tic) Data for Health Care Price Analysis

"Transparency in Coverage data represent a significant advancement in the availability of information on negotiated health care prices, offering researchers a new lens into variation across payers, providers, and markets. As demonstrated in [this analysis], TiC data can be used to replicate and extend findings from traditional claims-based research, particularly in understanding the range and distribution of negotiated rates across payers and providers."  MORE >>

Health Care Cost Institute

Benefits in General

[Official Guidance]

IRS Disaster Relief Announcement GA-2026-03, for Taxpayers Impacted by Wildfires in Southeast Georgia

"[B]usinesses in parts of Southeast Georgia that were affected by wildfires and straight-line winds that began on April 18, 2026 ... now have until Aug. 20, 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 Clinch, Echols, and Brantley counties qualify for tax relief."  MORE >>

Internal Revenue Service [IRS]

Employee Benefits Jobs

💼

Regional Manager - Third Party Administrator

CBIZ, Inc

Remote / Saint Petersburg FL

View job as Regional Manager - Third Party Administrator for CBIZ, Inc

Selected New Discussions

Paid Parental Leave

"My company is looking to enhance our Paid Parental Leave. Currently, we provide women & men 4-weeks of FT paid leave. This is on top of the maternity leave provided to the birthing mother. Our company is just about 1000 employees. I would love to get other company data to put into my research if you wouldn't mind sharing!"

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Webinars, Podcasts and Conferences
(Health & Welfare Plans)

Pharmacy Benefit Manager Contracting for Fully Insured and Self-Funded Group Plans

June 12, 2026 WEBINAR

BARBRI

Last Issue's Most Popular Items

Reminder: Exclusion of Interns from Health Coverage Could Trigger ACA Penalties

Haynes Boone

Fourth Circuit Outlines Factors to be Used When Evaluating ERISA Status of a Bonus or Incentive Plan

Boutwell Fay LLP

COBRA Subsidies and Reimbursement, Part 3: Reimbursing COBRA Through Prior Employer's Plan

Newfront

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

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