"For employers that already provide fertility benefits through their major medical plans and/or through fertility HRAs, it is unclear whether an employer would terminate their existing fertility arrangement in favor of an excepted fertility benefit program that has set dollar limits, or adopt an excepted fertility benefit to supplement their existing fertility coverage.... Excepted benefit status may assist employers who sponsor a fertility HRA to avoid the ACA-HRA integration rules[.]"  MORE >>

"Employers that have allowed insurers to market these types of voluntary programs to their employee populations, and who are currently taking the position that the DOL's voluntary plan safe harbor applies, should take a fresh and careful look at whether all of the elements of the safe harbor have been met with respect to their voluntary benefit programs."  MORE >>

"One change that could increase traffic in the IDR portal is a reduction in the administrative fee for IDR participants from $115 to $15 per case.... Although slashing the fee could further increase the number of IDR cases, the federal departments say other finalized provisions should counter that trend.... Payers face new claim communication requirements ... Open negotiation becomes a more structured step ... Batching rules and eligibility reviews will shape dispute volume ... IDR eligibility scrutiny is set to increase ... Payer identification should become easier"  MORE >>

"Beginning with the 2027 plan year, insurers will no longer be required to offer standardized plans ... HHS now believes that these plans are 'an ineffective strategy' to simplify the plan selection process, improve the consumer experience, and increase consumer understanding.... The final rule permanently removes the option for insurers to use fixed-dollar and gross-premium threshold flexibilities beginning with the 2027 plan year.... [T]he final rule will largely continue current risk adjustment policies, with narrow exceptions.... The final rule adopts a [risk adjustment] user fee rate of $0.18 per member per month for the 2027 benefit year, a slight decline from the $0.20 per member per month fee that applied for the 2026 benefit year."  MORE >>

"This decision adds to a growing split on whether providers may enforce IDR awards through private litigation. While the Fifth Circuit has held that no such right exists, this court and certain other federal trial courts have concluded otherwise, meaning that plans and insurers operating outside the Fifth Circuit may face greater exposure to enforcement lawsuits when they fail to pay IDR awards within the required 30-day window." [PHI Health, LLC v. Optimum Choice, Inc., No. 25-2320 (D. Md. Mar. 27, 2026)]  MORE >>

"The decision turns on two issues of interest to ERISA practitioners: whether the policy qualified as an ERISA-governed employee welfare benefit plan, and, after concluding that it did not, how Texas state law resolves a beneficiary dispute where the decedent signed a binding informal settlement agreement in pending divorce proceedings but died before the divorce decree was entered." [Principal Life Ins. Co. v. Jones, No. 25-0221 (S.D. Tex. May 27, 2026)]  MORE >>

"The PBM industry continues to evolve through legislative action, litigation, and voluntary industry changes. [This article provides] a brief round-up of recent developments including new federal and state legislation targeting vertical integration, an ERISA preemption challenge to California's PBM reform law, and a new pharmacy care model announced by Optum Rx."  MORE >>

"A DCFSA is one of the few benefits that costs relatively little to offer but delivers real, recurring value to employees. Working parents notice when their employer helps them solve an actual problem, and a DCFSA does exactly that during the most expensive childcare months of the year."  MORE >>