"This Carrier Letter includes the 2027 Community Rating Guidelines and Proposal Instructions for Federal Employees Health Benefits (FEHB) Program and Postal Service Health Benefits (PSHB) Program Carriers. FEHB and PSHB plans must be rated separately based on the population covered." [Also available: MLR Threshold; Proposal Tables (XLSX)]  MORE >>

"Although the Plan is a non-ERISA governmental plan exempt under 29 U.S.C. Section 1003(b)(1), the court applied an arbitrary-and-capricious standard derived from New York contract law that closely mirrors ERISA review of plans vesting discretion in the administrator. The decision is significant for ERISA practitioners because the panel borrows substantively from ERISA case law to define the scope of judicial review, the limits on discovery, and the treatment of treating-physician opinions." [Martin v. Fed. Rsrv. Bank of Cleveland, No. 25-3518 (6th Cir. May 7, 2026)]  MORE >>

"As the line of cases emphasizing disparate limitations continues to grow, the emphasis is not just on the availability of other types of mental health care. As a result, courts nationwide have found potential MHPAEA violations in several cases involving wilderness programs." [Allison B. v. BlueCross BlueShield of Ill., No. 24-6162 (N.D. Ill. Feb. 20, 2026)]  MORE >>

"The spate of voluntary benefits cases presume that the benefit programs at issue are all considered to be employee welfare benefit plans under ERISA. Courts have not yet ruled definitively on how or if ERISA applies to voluntary benefits. The most recent case, ... as in other similar complaints, argues that the defendants breached their fiduciary duties by failing to properly manage the plan by not monitoring, negotiating or ensuring reasonable carrier selection, broker commissions and loss ratios, thereby causing plan participants to pay excessive premiums." [Haller v. Banner Health, No. 26-3114 (D. Ariz. complaint filed May 4, 2026)]  MORE >>

"The number and variety of behavioral health products for mental health and substance use disorders (SUDs) have increased exponentially over the past decade, with tens of thousands of products now in the marketplace.... This article presents an overview of today's behavioral health products and describes six best practices for designing behavioral health benefits that will help your people."  MORE >>

"Rather than continuing to layer new offerings onto an outdated framework, a growing number of organizations are rethinking benefits at the foundational level and shifting toward a flexible 'build your own benefits' approach. This model gives employees a defined allowance or a set of options they can tailor to their individual priorities, whether that includes traditional healthcare, caregiver support, wellness benefits or less conventional offerings like pet insurance. This shift reflects a broader reset in total rewards strategy."  MORE >>

"If enacted, the legislation [HR 8314] would allow employers to establish a 'Qualified Benefit Options Plan,' permitting current and former employees to direct their employer contributions to benefit programs that meet their specific needs. The contributions to eligible tax-favored employer-provided benefit programs would be allocated without triggering taxable income solely due to that choice. The available benefits would include: [1] Nonelective contributions to a retirement plan; [2] Health savings account or health reimbursement arrangement contributions; [3] Qualified educational assistance benefits (including student loan repayments); [4] 'Other benefits which are excluded from gross income' under the Internal Revenue Code."  MORE >>