"The 2024 benefit year HHS-RADV error rates will be applied to 2024 benefit year plan liability risk scores and risk adjustment State transfers.... This memo contains a summary of the 2024 benefit year HHS- RADV results, and information to assist issuers in understanding their results.'

• National Program Benchmarks -- 2024 Benefit Year HHS-RADV (XLSX)
• 2024 Benefit Year RA State Market Risk Pool Weighted Average HHS-RADV Error Rates (XLSX)
• 2024 Benefit Year HHS-RADV Failure Rate Group Definitions (XLSX)
• 2024 Benefit Year HHS-RADV HCC Validation (XLSX)

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"[T]he Proposed Rule would, for the first time, allow employers to offer fertility benefits -- including in vitro fertilization (IVF) -- outside the federal market requirements added by [HIPAA], the [ACA] and related statutes. However, that offer of fertility benefits is also subject to some conditions."  MORE >>

"Although not intended, the new federal programs have the potential to introduce both direct and indirect medical and drug costs to group-based plan sponsors, beginning as early as July 2026. Further, if the BALANCE Model launches as planned in 2028, group-based plan sponsors will face a decision. They can participate in the program to offer GLP-1s to retirees on a group basis and take on the associated costs or they can direct retirees to the individual Medicare marketplace to obtain GLP-1s and other Medicare medical, drug, and ancillary benefits."  MORE >>

"Although this is the fourth cycle of negotiations between Medicare and drug companies, this is CMS's first time engaging in the rulemaking process, as the IRA authorized CMS to administer the MDPNP through guidance for the first three years of the program.... [This article describes] how CMS's procedural transition from guidance to rulemaking may impact the functioning of the program. [The authors also] describe and analyze the substantive policies that CMS added or changed from previous negotiation cycles."  MORE >>

"Although the PFML law has been enacted, the VEC is expected to develop implementing regulations by sometime in 2027, with contribution rates required to be set by October 1, 2027.... Employers with voluntary PFML plans may be exempt from the state program, subject to VEC approval, if the benefits they provide are at least equal to those under the state program."  MORE >>

"[T]he Rules expand the Ordinance's regulatory reach by bringing joint and successor liability squarely within its ambit ... [T]he Rules address the City's immigrant workforce directly, clarifying that '[i]mmigration status does not affect an individual's status,' thereby ensuring that concerns about immigration standing do not deter workers from asserting their rights under the Ordinance.... Where the Ordinance left gaps or ambiguities in its requirements, the Rules step in to resolve them -- and in doing so, further broaden the scope of employee protections in ways that employers must carefully implement."  MORE >>

"[The plaintiff] contended that [the employer] was a proper defendant because the SPD gave it the authority to make benefit determinations. The court disagreed ... The court emphasized that the plan required that all proof of claim be routed through Prudential ... The court noted that in so ruling it was 'align[ing] ourselves with five other circuits.' " [Justman v. Accenture LLP, No. 25-2084 (3d Cir. June 17, 2026)]  MORE >>

"Plaintiff alleged that Cigna denied his claims roughly 50 times and issued forms stating that it denied the claims because it did not pay for services performed by unlicensed providers, which Plaintiff contended falsely represented that he was not licensed to practice medicine.... The court rejected Plaintiff's argument that defaming a provider does nothing to establish fiduciary standards, explaining that the correct inquiry is whether communicating benefits determinations to beneficiaries is a central matter of plan administration, and it is." [Ahn v. Cigna Health and Life Ins. Co., No. 25-1723 (3d Cir. June 24, 2026)]  MORE >>

"One way to approach the challenge ... is to offer a lifestyle spending account (LSA) and add GLP-1 medication and support resources to the list of covered expenses. [Employers could also offer a] specialty care account benefit (SCA), dedicated specifically to areas like weight loss, hormone replacement, and mental health support.... SCAs are regulated because they are a healthcare benefit, and employers can offer up to $2,200 pretax ... Both of these benefit options allow employers to apply a fixed allowance toward selected health and wellness expenses, helping them establish cost predictability while enabling employees to spend funds on what they value most."  MORE >>

"Two-thirds of voters said that the federal government should make 'stop[ping] hospitals from charging excessive prices' their top priority -- more than any other policy proposal. Support for reining in hospitals' ever-higher prices is decisive across partisan and demographic lines ... Six in 10 voters said reining in surprise medical billing by providers should be a top priority -- the second-highest priority of all proposals tested."  MORE >>

"Senate Bill 1545 ... would prohibit PBMs from owning or holding permits for the retail sale of prescription drugs in Arizona beginning January 1, 2027. While the bill remains in the early stages of the legislative process, it has already attracted attention because it goes beyond traditional PBM reform measures and directly targets vertical integration and follows a growing trend of similar bills."  MORE >>

"[TPAs], brokers, and benefits technology vendors are increasingly offering [AI] tools that can generate [SPDs], plan summaries, FAQs, and participant communications almost instantaneously. While these tools promise efficiency and reduced administrative burden, plan sponsors should proceed cautiously. Under ERISA, the plan administrator is responsible for maintaining compliant plan documentation and properly distributing required disclosures, including the obligation to furnish paper copies of plan documents upon a participant’s request."  MORE >>