"The ACA generally prohibits a retroactive termination of an employee’s or dependent’s medical coverage through the employer’s plan, referred to as a “rescission” of coverage. A few limited exceptions apply with procedural protections, such as when the individual engages in fraud or makes an intentional misrepresentation of material fact."  MORE >>

"OPM said beginning July 1, federal workers who enroll a child or spouse in health insurance benefits through FEHBP or PSHBP will be required to provide proof of their eligibility.... While much of the rule is aimed at improving eligibility verification when a dependent is first added to insurance coverage, OPM said it is still preparing for the FEHB Protection Act's other major provision: an audit of existing enrollments to verify participants' continued eligibility."  MORE >>

"Overall, the Final Rule is intended to streamline dispute processing, reduce ineligible claims, and ensure faster and more consistent payment determinations, although ... it will take some time for these changes to provide any meaningful relief to the overly strained IDR process, if at all.... The Final Rule includes a number of different applicability dates for the various changes, which are noted below. The Final Rule applies to plans, issuers, and Federal Employees Health Benefits (FEHB) carriers and their plans (collectively, plans and issuers)."  MORE >>

"Many employer and other plan sponsors and fiduciaries ... are surprised to discover their plans and they are exposed to or actually have already paid significantly higher than projected out-of-network costs due to the use of cost data indefensible under these rules, failures by their vendors to timely handle or other bungling of IDR rules responsibilities or both.... Keeping in mind that the [DOL] views NSA administration and selection, oversight and management, and compensation of vendors as fiduciary conduct, employers also should verify that vendors handling these duties assume named fiduciary status for these responsibilities[.]"  MORE >>

"While the Report reflects a general increase in many types of letters issued, it also shows a reduction in insufficiency letters, which the Departments noted was the result of plans and insurers promptly removing problem limitations prior to an insufficiency finding."  MORE >>

"67% of employers view voluntary benefits as a vital part of their financial wellbeing strategy. 63% of businesses have operationalized AI within parts of their operations, a significant jump from 45% in 2025. 48% of employers now cover infertility services or fertility treatments. 32% of employers are now 'carving out' their pharmacy benefits to a separate Pharmacy Benefit Manager (PBM), up by 13 points from 2024."  MORE >>

"This post gives HR leaders a practical framework for quantifying benefits ROI in financial terms, covering turnover costs, absenteeism, health plan spend, and what finance teams actually want to see when you walk into that conversation."  MORE >>

"Hospital spending is now the largest single component of insurance premiums, and it has surpassed $1.6 trillion nationally. That number is the product of decades of anticompetitive consolidation, wildly inconsistent rates for identical services, opaque black-box pricing, and a growing private equity presence within hospital systems."  MORE >>