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Will Cancer Detection Tests Cause the Next Cost Explosion?

"Early detection is great, isn’t it? It will save money down the road, so shouldn’t we cover it? Before you decide to do so, consider these six points that the Validation Institute would argue go exactly the other way."

Your PBM Is the Problem

"Two of the biggest sources of traditional PBM profit are dispensing margin on specialty drugs and retention of manufacturer rebates. Both are calculated as a factor of list prices -- and as those list prices increase, so does your PBM's profitability.... [A] closer look at supply chain economics reveals that pharma's net profit on brand drugs may actually be shrinking, and generic drugs have been steadily deflating for 10 years or more. If prices at the counter continue to rise while manufacturers' profits fall, where are those dollars all going? They are quietly absorbed by the world's most sophisticated middleman, the traditional PBM."

One State Slashed Public Employee Insurance Painlessly. So Can West Virginia.

"West Virginia public employees could see double-digit percentage rate hikes in their insurance over the next few years. To many this is just the result of an aging population. But it is also caused by a broken system that lets powerful interests in the healthcare industry just keep raising prices to boost profits, with almost zero pushback or oversight.... But there are actually plenty of steps [the Public Employee Insurance Agency (PEIA)] could take to close this deficit quickly, without affecting quality of care."

Health Plans Need to Go Farther To Get Us Through the COVID-19 Crisis

"To keep health care services readily available through this crisis and beyond, we need health plans to provide bridge financing, advancing operating funding for 120 days and paying for telemedicine at the same rate as in-person visits.... Payers wouldn't exist without providers. Most important, members need access to these providers to get health services in their homes. Stable revenue flow is clearly an all-around win, in the interests of patients, providers, payers and employers."

Waiving the 60-Day IRA Rollover Rule

Excerpt: Under Revenue Procedure 2003-16, taxpayers seeking a waiver must apply for a private letter ruling unless, in an otherwise valid rollover, the lapse is due solely to an error by the depositing financial institution and the funds are deposited into an eligible plan within one year from the beginning of the 60-day period.

Generative AI: A Roundtable Peer Discussion (PDF)

20 pages. "In March 2025, the SOA Research Institute convened a panel of industry experts to discuss the advancements and implications of generative AI (GenAI) in the insurance industry.... [T]he panelists discussed and covered the following key topics with respect to AI: [1] How GenAI is currently being used; [2] Using vendor tools or building tools in-house; [3] Privacy; [4] Compliance, governance and ethics; [5] Risk management; [6] Model validation; [7] Challenges; [8] The impact on actuaries."

Eighth Circuit Upholds Dismissal of ERISA Lawsuit Alleging Excessive Recordkeeping Fees

"The court explained that had the plaintiffs alleged that the services purchased were sufficiently similar to render the comparisons valid, their claims might have been plausible. The court also explained that the plaintiff's other allegations rely on aggregate data from the Investment Company Institute, but this data does not identify the cost structure of individual plans, just the overall costs." [Barrett v. O'Reilly Auto., Inc., No. 23-2501 (8th Cir. Aug. 29, 2024)]

Joint Trade Associations Comment Letter to DOL on Proposed 408(b)(2) Focus Groups (PDF)

"We believe this review of the 408(b)(2) regulation is premature and based on unidentified anecdotal evidence of small businesses that is contrary to the actual experience of our members. In particular, it is our view that: [1] It is premature and imprudent to propose to amend the section 408(b)(2) regulation to add more disclosure rules before determining whether any changes are needed (and whether the costs of those changes justify whatever benefits the Department identifies). [2] The proposed focus groups are not properly constructed because [a] they ignore large-plan fiduciaries, and [b] they rely upon recollection of disclosures th at plan fiduciaries received almost two years ago. [3] The focus group 'script' contains a number of biases that could prevent the results from being reliable and valid."

Defined Benefit Pensions: Still the Best Bang for the Buck (PDF)

[A recent TIAA-CREF/Arnold Foundation paper] fails to offer a concrete cost analysis that supports their assertion that DC plans provide benefits at a cost equivalent to that of DB plans. NIRS stands by our research. The structural DB cost advantages quantified in [the 2008 NIRS Study] 'A Better Bang for the Buck' -- derived from well-documented research on investment returns, fees, and asset allocation -- remain valid based on current data about DB and DC plan features and performance."

Achieving the Potential of Health Care Performance Measures

"This report provides an overview of performance measurement in U.S. health care, and includes policy recommendations aimed at improving the performance measurement enterprise. Specifically, they recommend how to develop better measures; when and how to use measures; and how to ensure the validity and comparability of publicly-reported performance measure data."