"Even if you are not a hospital or insurance company, your self-funded health plan may qualify as a 'covered entity' under the Health Insurance Portability and Accountability Act. That can create potential legal exposure for both you, as the employer, and for your Third Party Administrator."  MORE >>

"Under a law enacted last year, five of Indiana's largest nonprofit hospital systems cannot charge patients covered by job-based health plans more than an established price cap. Hospitals that fail to keep prices below the threshold by 2029 risk losing their tax-exempt status ... Even before that penalty kicks in, the law requires these hospitals, which control nearly half the state's hospital market, to offer direct-to-employer contracts -- bypassing insurers -- and stay within limits set by the state. Hospitals that don't comply face a $10,000-a-day penalty. Many other Indiana hospitals must comply with this provision beginning in September."  MORE >>

"The decision shows how an insurer's own post-denial communications can create a fact question about where a claimant was required to send an appeal, defeating an exhaustion defense that might otherwise have ended the case." [Lucas v. Hartford Life and Accident Ins. Co., No. 24-7561 (S.D.N.Y. June 18, 2026)]  MORE >>

"The decision is a reminder that even a well-grounded ERISA long-term disability claim can stall at the pleading stage when the complaint does not clearly separate its claims and identify which defendant each claim is brought against." [Isoviv v. Hartford Life and Accident Ins. Co., No. 25-5865 (N.D. Ga. Jun. 18, 2026)]  MORE >>

"[T]wo-thirds of clients (66%) currently cover GLP-1s for obesity, and most intend to continue doing so. Few clients that do not cover GLP-1 drugs for obesity are considering adding them.... This finding is consistent with [WTW's] 2025 Best Practices in Healthcare Survey, where 57% of employer respondents indicated coverage of GLP-1 medications for obesity.... 74% are considering or already using a clinical wrap to support appropriate utilization, engagement and outcomes."  MORE >>

"Most employers are overpaying for healthcare by about $4,000 per employee each year, and the first step in reclaiming that lost profit is establishing proper governance and oversight. However, even the most robust fiduciary committee charter is only as effective as the adviser who guides it."  MORE >>

"The national median total cost for a C-section for commercially insured patients staying in network is $19,911 ... Alaska is the state with the highest median allowed amount for vaginal deliveries ... followed by (in order from highest to lowest) New Jersey, New York, Connecticut and Oregon. Alaska also has the highest median allowed amount for C-sections ... followed by Vermont, Maine, Oregon and Wyoming. Alabama has the lowest median allowed amount for vaginal deliveries ... [and] also has the lowest median allowed amount for C-sections[.]"  MORE >>