"For applicable large employers (ALEs) that outsource the Forms 1094-C and 1095-C filing process to a third-party vendor, this enforcement reality has exposed a quietly devastating fact: the IRS does not care what the vendor told the employer. The IRS cares about what the vendor actually transmitted to the IRS and the only document that proves a transmission was received and accepted is the Receipt ID."  MORE >>

"The NPRM does not appear to cover elective fertility treatments for those without an infertility diagnosis (for example, elective egg-freezing). There is a brief indication in the preamble that the Tri-Agencies may intend to provide employers more flexibility to cover additional benefits.... [P]lan sponsors who wish to rely on this new limited excepted benefit will want to ensure that the benefits provided fit into the final definition of 'fertility benefits' once published."  MORE >>

"In final regulations ... [CMS] introduced several updates intended to simplify compliance and reduce administrative burdens ... This article outlines the key regulatory changes, including a new exemption for account-based medical plans from the Part D creditable coverage reporting requirements, and the phase-out and replacement of the former simplified determination method for determining group health plan creditable coverage status, and highlights practical considerations for plan sponsors preparing for the new requirements."  MORE >>

"Beginning today, TrumpRx.gov will feature more than 600 generic medications. Americans will be able to clearly and transparently understand the most competitive cash prices of their medications without insurance middlemen, encouraging them to compare against co-pays offered by their insurance company. Patients will be able to compare the best cash prices available to them at their local pharmacies and through delivery options offered by various private pharmacy programs."  MORE >>

"This year's final rule [is] among the more ambitious rules in terms of the scope and scale of the changes. The final rule touches on topics such as expanded access to catastrophic plans with even higher out-of-pocket costs; new rules for the defrayal of state-mandated benefits; burdensome verification requirements; the elimination of standardized plans; and new policies to implement various provisions of the One Big Beautiful Bill Act (OBBBA). HHS finalized most of the changes in the proposed rule, although it delayed implementation of some of these policies and reduced user fees."  MORE >>

"The rules primarily clarify existing requirements and expectations, including permissible use in childcare disruption scenarios, and employer authority to address patterned misuse, while introducing explicit standards for joint‑employer and successor liability and reaffirming that compliant combined PTO policies remain permissible."  MORE >>

"ERISA class actions targeting voluntary benefits are on the rise. Plaintiffs allege employers and brokers breached fiduciary duties through self-dealing and excessive commissions. The strongest defense is proving ERISA doesn't apply. The DOL safe harbor exempts programs where the employer doesn't contribute, participate, or endorse beyond minimal involvement. Employers should take proactive steps now. Audit safe harbor compliance, document governance processes, and map all service provider compensation."  MORE >>

"For years, the claims experience has been one of the most friction-heavy touchpoints in healthcare.... [T]wo major plans [are] addressing this from different angles: Aetna through contextual cost explanation at the point of confusion, and UnitedHealthcare through a structured, self-service submission overhaul.... One tackles post-service, helping members understand a claim after it has been processed. The other addresses submission, reducing friction when members initiate a claim. Together, they reflect a maturing view of what claims look like in the digital experience."  MORE >>

"While available data on premium payments is mainly from January, a few states that run their own ACA markets have released information for later months. The sharpest drop in people paying premiums, based on limited data, is in Georgia, which saw a 28% drop in April compared with the same period a year ago ... The initial results come amid rising public concern about affordability[.]"  MORE >>

"When a carrier can automate a simple auto or workers' comp claim in-house or buy that capability from an AI-native competitor at outcome-based pricing, every manual-labor full-time equivalent on a TPA's P&L becomes a margin drag, not a moat. The acquirer's playbook that built the industry's current champions will not build the next decade's winners.... The next decade's TPA champion will be the first mover that credibly prices its AI-enabled service below the carrier's in-house build-or-buy alternative, and backs that price with outcome-linked accountability."  MORE >>

"For decades, the standard insurance carriers have ... convinced self funded employers that without a legacy PPO network, their plans would collapse into a chaotic mess of balance bills and member disruption.... But the landscape of commercial health insurance just shifted permanently in Indiana. The Hoosier state has done something entirely new, and it provides an exquisite blueprint for how forward thinking employers can completely eliminate the legacy carrier network once and for all."  MORE >>

"In the document-heavy world of retirement and benefits plans, attorneys tell of how AI has changed -- some for the better, some for the worse, some to be determined -- the way some legal work is done. Legal experts say plan sponsors can best use the technology through AI legal review, such as reviewing documents, which allows plan sponsors to be more informed when they meet with counsel. They caution, however, that they could violate their fiduciary duties by over-relying on the technology."  MORE >>