"The proposed rule allows employers to offer fertility benefits as a standalone option that qualifies as a new category of limited excepted benefit, similar in concept to standalone dental and vision coverage.... [E]xcepted benefits are generally exempt from many federal market reforms that apply to group health plans, including certain requirements under the [ACA] and HIPAA. As a result, employers could design fertility benefit programs with greater flexibility, potentially reducing administrative burdens and expanding employee access."  MORE >>

"The best practice is to offer rewards (such as premium reductions) on both a prospective and retroactive basis. This ensures the 'full reward' is provided to individuals who satisfy the [reasonable alternative standard (RAS)].... Ensure that annual enrollment guides adequately discuss the tobacco premium surcharge or the process for avoiding it through RAS.... Employers should remember their fiduciary duties and how they use the amounts collected by surcharge. Be sure to properly allocate the surcharge amounts toward paying claims and administrative expenses."  MORE >>

"These final rules represent a significant step in the agencies' ongoing efforts to address inefficiencies in the federal IDR process, which has been burdened by high dispute volumes and complex eligibility determinations. Plan sponsors and their advisors should take note of the new communication requirements as these will require coordination with insurers, TPAs, and other service providers. Self-insured health plans should be particularly attentive to the updated batching rules, which differ in important respects from the proposed rules."  MORE >>

"Shortly before the PL/PSSL Ordinance took effect on July 1, 2024, OLS published implementing rules. These have been amended by the 2026 PL/PSSL Rules. Most of the revisions are semantic, consisting of minor wording adjustments, re-ordered definitions, and grammar adjustments. But a few are noteworthy clarifications."  MORE >>

"Reading the eligibility waiting period to require continuous active employment for its entire duration was not unreasonable, the court [said], because the waiting period appeared to encompass more days than just the 30 days of continuous active employment needed to reach the Eligible Date. The court was candid that the policy did not expressly require this reading and that the interpretation 'may be low on the reasonableness scale.' But under abuse-of-discretion review, a low-end-but-rational interpretation is enough, and the court declined to find an abuse of discretion on that basis." [Richards v. Lifepoint Health Welfare Benefits Plan, No. 25-3541 (N.D. Tex. May 27, 2026)]  MORE >>

"Stern's holding that the employer was not acting as an ERISA fiduciary in connection with the challenged conduct is a key victory for employers. Navarro II and Lewandowski II did not address whether the challenged conduct was subject to ERISA's fiduciary standards because those courts dismissed the plaintiffs' claims for lack of Article III standing.... Stern's application of the 'meaningful benchmark' standard to a health plan is an important development that may impact whether plaintiffs in future cases alleging excessive health plan costs can plausibly allege a claim for relief." [Stern v. JPMorgan Chase & Co., No. 25-2097 (S.D.N.Y. Mar. 9, 2026)]  MORE >>

"[T]hree actions [that] could move the needle to advance affordability: [1] Policymakers could clarify when ERISA's fiduciary duties apply to [PBMs] and [TPAs], and identify examples of compensation schemes or other contracting and business practices that may violate these duties. [2] Congress could amend ERISA to directly regulate more PBM, TPA, and other service provider conduct, both to enhance oversight over its transparency requirements and to prohibit or limit anticompetitive contracting behavior and other abusive business practices. [3] Congress could provide the DOL with resources and authority to more actively support employers in their role as health care purchasers."  MORE >>

"[1] Clarify eligibility requirements.... [2] Create verification procedures.... [3] Determine consequences of lying about spousal circumstances.... [4] Establish the surcharge amount.... [5] Make exceptions.... [6] Examine contracts or collective bargaining agreements (CBAs).... [7] Communicate with employees.... [8] Update plan documents and summary plan descriptions (SPDs).... [9] Consult legal counsel.... [10] Coordinate with payroll and benefit systems."  MORE >>

"Although recent court decisions are mixed, cautious group health plan sponsors should assume that participants who complete a cessation-based reasonable alternative standard (RAS) midyear are entitled to the full value of that year's tobacco-related reward, requiring a retroactive refund or equivalent credit."  MORE >>

"While median rate increases remained relatively steady, the distance between the lowest and highest renewals widened sharply, making costs harder for employers to predict. Employers ... [are] making smaller adjustments across premiums, plan design, and cost sharing.... [P]lanning for 2027 requires a closer look at where their organization may fall within a much wider range of outcomes and how those outcomes could affect employee affordability and talent attraction and retention."  MORE >>

"Akin to other employment-related contracts, severance agreements are governed by applicable federal and state law. When drafting, negotiating, and enforcing a severance agreement, an employer must avoid various pitfalls, comply with federal and state statutes, and afford the departing employee certain rights. Not doing so may cause the severance agreement to be unenforceable, in whole or in part, and may subject an employer to wrongful termination claims or other redress."  MORE >>