BENEFITS DIGEST

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A publication of The Inner Firm

Friday, September 18, 2026

№ 55

18 items · ~9 min read

Regulatory & Guidance (1)·Retirement Plans (4)·Health & Welfare (7)·Leave & Time Off (1)·Court Decisions & Case Commentary (4)·Also Noteworthy (1)

The Two Things

The First Thing: Congress has passed a bill giving employee stock ownership plans something they have never had, a clear rule for valuing the company shares they buy. An ESOP can face a lawsuit, often from the Department of Labor, if it pays too much for those shares, and for decades there has been no regulation saying how to get the price right. The Retire Through Ownership Act, which passed the House 401 to 14 on Wednesday after clearing the Senate unanimously last fall, would let the people responsible for the plan rely in good faith on an independent appraisal that follows the IRS's longstanding valuation framework, Revenue Ruling 59-60. It would not relieve them of the duty to act prudently. The bill is on the President's desk, and the safe harbor would apply to valuations made on or after the day he signs.

The Second Thing: Winning a payment dispute is not the same as getting paid. East Coast Advanced Plastic Surgery won more than $3 million in arbitration awards against Cigna and says it has not received the money. In Thursday's opinion, the Second Circuit held that the No Surprises Act gives providers no right to sue under the Act to collect those awards. Enforcement belongs to the Labor Department, Treasury, HHS and the states, and the ruling joins the Fifth Circuit, the only other appeals court to decide the question. The timing is the story. Georgetown's new analysis of the 2025 data puts the provider win rate at 88 percent in the first half of last year, the highest recorded, in a system that has absorbed 4.8 million disputes since opening in 2022 against the 17,000 a year Congress projected. Employers, meanwhile, spent the week telling Congress those disputes are driving up their health-plan costs. Providers hold awards the courts will not enforce for them, and employers want the arbitration reined in. POLITICO's reporting says both sides see the year-end spending bill as the chance to change the law.

The Skinny

Employee ownership. Congress passed a bill letting ESOP fiduciaries rely in good faith on qualifying independent appraisals. It awaits the President’s signature.

Surprise billing. A federal appeals court says providers cannot sue under the No Surprises Act to collect unpaid arbitration awards.

Pension exits. The Seventh Circuit split with two other courts over how to credit an employer’s earlier partial withdrawal, a difference worth up to $9.3 million in this case.

Mental health coverage. This week’s federal guidance gives employers specific plan terms and administrative practices to check.

Maryland paid leave. Employer registration is open, and employers weighing private coverage face a November 15 deadline.

Regulatory & Guidance (1)

The Retire Through Ownership Act Passes the House 401–14 and Heads to the President
U.S. Congress · S. 2403 2026-09-16

The mechanics behind the First Thing, from the bill text. The new ERISA §3(18)(B) would let an ESOP fiduciary rely in good faith on a fair-market-value determination by an independent valuation expert or business appraiser who “relied upon the principles and methodologies set forth in Internal Revenue Service Revenue Ruling 59-60,” as the IRS amplifies and modifies it over time (weighted earnings, assets, and comparable-company analysis). Two caveats matter for counsel. The bill expressly leaves ERISA §404's prudence duties untouched, so the safe harbor would protect the price standard, not a sloppy process. And the Labor Department could still issue regulations. It would apply to valuations made on or after enactment.

Retirement Plans (4)

Advisors Would Have Another Tool to Help Fraud Victims Under House-Passed Bill
Financial Planning 2026-09-16

The week's second lopsided retirement vote. The Tax Relief for Fraud Victims Act, H.R. 9500, passed the House 408 to 17, sponsored by Representatives Max Miller of Ohio and Thomas Suozzi of New York. Victims persuaded to drain retirement accounts today owe the 10 percent early-withdrawal penalty on money a scammer took, and since 2018 they have had no theft-loss deduction. The bill waives the penalty, restores the deduction, extends refund deadlines, and allows one year from discovering the loss to repay the distribution back into the plan. It awaits a Senate vote.

Trump Accounts: Proposed Regulations Regarding Eligible Investments
Boutwell Fay 2026-09-17

A comment deadline is approaching on the investment side of the accounts we covered all week. October 20 is the date for the August proposed regulations defining what a Trump Account may hold. The proposed rules are strict. Mutual funds or ETFs only, tracking the S&P 500 or another broad U.S. equity index (no sector, ESG-focused, or actively managed funds, and no leverage), with annual fees capped at 0.1 percent of assets. Under the proposal, trustees would offer only eligible funds, name a default, monitor eligibility annually, and unwind any fund that falls out of compliance within 30 days. The investment menu would stay deliberately narrow, and employers considering contributions should understand those limits before describing the benefit to employees.

How Can Employers Boost Workers' 401(k)s? Student Loan Matching.
HR Dive 2026-09-17

The adoption story behind the EBRI numbers we ran Tuesday and Thursday. One in five 401(k) participants between 25 and 69 carries student debt, and among those borrowers the under-saving runs deep. Sixty-one percent defer less than 6 percent of pay, a pattern EBRI finds at every income level. SECURE 2.0's answer lets employers match student-loan payments as if they were 401(k) deferrals. eBay had already budgeted for every employee to take the full match and already had 96 percent participation in its plan, which is why its benefits manager calls adding the student-loan match “kind of a no-brainer,” per HR Dive's account.

Health & Welfare (7)

Department of Labor Issues Guidance on Mental Health Parity Enforcement
Aon · Compliance & Policy Consulting 2026-09-16

Thursday's issue carried the government documents themselves, the enforcement bulletin and EBSA's red-flag checklist. Today we turn to the client briefing, which earned a slot of its own. Submitted by Aon's U.S. Health Solutions Compliance & Policy Consulting team, the four-page bulletin by Rebecca Sooter and Kristen Boorman explains EBSA's decision to concentrate parity enforcement on the three treatment-limitation categories it says carry the “highest potential for significant harm to plan participants.” Those are exclusions and separate limitations, medical-necessity review processes, and network adequacy, with authority reserved to investigate anything else “particularly in the context of participant complaints.” Aon's recommendation is the practical place to start. Get the comparative analyses from your vendors now and test them against the three priorities, using the red-flag page as the checklist.

Industry Titans’ Warning to Congress: Do What We Say or Health Insurance Premiums Are Going Up
POLITICO 2026-09-17

The employer coalition opened a new front in the No Surprises Act fight. The ERISA Industry Committee, whose board includes ExxonMobil, Lockheed Martin, PepsiCo and Walmart executives, released a report Thursday and briefed both chambers, arguing arbitration fees are landing on self-funded plans. One employer reports more than $6 million in dispute payments in the first half of the year, and Mercer projects employer coverage costs up 8.5 percent next year, the steepest climb in nearly a quarter century. ERIC wants awards anchored to the in-network benchmark rate, the approach the Fifth Circuit's August ruling (covered here September 11) held had let insurers keep rates artificially low, and the doctors' groups and their House allies call that a non-starter. Everyone agrees on the vehicle: the year-end spending bill.

For Providers, IDR May Turn Claims Into Recovery
Davis Wright Tremaine 2026-09-17

The provider-side counterweight, built on Georgetown's analysis of the 2025 dispute data that both sides are citing. Providers won 88 percent of disputes in the first half of 2025, the highest rate recorded, and median awards ran at multiples of the in-network benchmark. DWT's tally by specialty tops out at roughly 32 times the benchmark for breast implant and reconstruction, the specialty of the provider who just lost the Second Circuit enforcement case above. The firm's advice to providers is direct. With the filing fee cut from $115 to $15 per party in June, and eligible claims from the same patient visit now allowed to be combined into one dispute, underpayments once too small to arbitrate may be worth pursuing. Their answer to the cost critique is that rising IDR spending reflects meritorious claims, not a broken system.

Why HaloMD Became a Target — And What Its Top Lobbyist Says Critics Get Wrong
Healthcare Dive 2026-09-17

Inside the firm at the center of the volume fight. HaloMD files roughly a fifth of the nation's IDR disputes for more than 150 medical groups, mostly small and mid-sized independent practices, wins over 90 percent of them, and draws median payouts nine times in-network rates. Patrick Velliky, its chief external affairs officer, concedes the research assumptions critics attack while insisting the underpayment problem is real. “On the payer side, there are companies that offer $1 or $0,” he says, and the lawsuits, he argues, came because small groups “would suddenly be able to stand up for themselves.” He even endorses one reform, CMS scrutiny at recertification of whether arbiters lean toward the parties that bring them business. The machinery keeps growing either way. HHS just certified Physio Solutions, doing business as Meditlitix, as the seventeenth IDR entity.

DOL Signals a Lighter Touch on Mental Health Parity Enforcement (for Now)
Sheppard Mullin 2026-09-16

One more word on parity this week, for what it adds to the calendar. Sheppard Mullin's team reads the new enforcement bulletin as “a reprioritization, not a reprieve,” and keeps the timeline in view. The agencies have committed to a replacement proposed rule by December 31, the industry challenge to the 2024 rule is still pending, and whether outcomes-based access standards survive remains an open question, so the landscape could shift again before year-end. Their caution is worth adopting now. Document the reasoning behind outcomes-data decisions, because the self-compliance tool alone will not carry a plan through whatever comes next.

Employer-Sponsored Health Plans Could Receive Trillions in Federal Tax Subsidies Over Next Decade
Hall Benefits Law 2026-09-17

The number behind every future fight over the tax break for employer-provided health coverage. CBO and the Joint Committee on Taxation now put the federal subsidy for employment-based coverage at $6.6 trillion over the next decade. The 2026 figure alone is $471 billion, about 25 percent higher than projected in 2023, driven by higher service costs, higher utilization, and higher enrollment. Hall's point for sponsors is that numbers this size invite exclusion caps whenever Congress needs revenue, so the tax treatment employers take for granted is a policy choice with a growing price tag.

Building Benefits: ERISA Insights for Construction Employers Dependent Coverage, Spousal Surcharges, and Opt-Out Payments Without Creating New Risks
Saul Ewing 2026-09-16

Written for construction employers, useful to any sponsor. A significant share of health plan cost is driven by who else is covered. Dependent-eligibility audits catch ineligible dependents whose claims an insurer or stop-loss carrier may refuse. Spousal surcharges and carve-outs raise consistency, Medicare and TRICARE questions. Opt-out payments must be structured through the cafeteria plan and counted in ACA affordability math. Each approach asks employers to weigh potential savings against administration, documentation and compliance obligations, and Saul Ewing's four-question checklist (clear eligibility definitions, administrative feasibility, interaction with other requirements, workforce impact) is the useful takeaway.

Leave & Time Off (1)

Court Decisions & Case Commentary (4)

No Private Right of Action to Enforce IDR Awards, the Second Circuit Rules
E. Coast Advanced Plastic Surgery v. Cigna, 2d Cir. 2026-09-17

The case behind the Second Thing, and what the lead leaves out. This was a two-front war. Cigna sued first, alleging ECAPS's billing caused $8.5 million in overpayments, and ECAPS answered with the enforcement suit the court just ended. Judge Park's opinion, joined by Judge Leval and Judge Rakoff sitting by designation, resolves a split among district courts, including within the circuit, and rejects the Declaratory Judgment Act as a workaround because it “does not create an independent cause of action.” The panel did not reach Cigna's broader argument that the Act's judicial-review bar independently forbids such suits, so that question awaits another case. MultiPlan, dismissed below, did not participate in the appeal.

The Seventh Circuit Splits With Two Circuits on When the Partial-Withdrawal Credit Applies
Consumers Concrete Corp. v. Central States, 7th Cir. 2026-09-17

When an employer leaves an underfunded multiemployer pension plan, it owes an exit payment, and an employer that made an earlier partial exit gets a credit for what it already owes. The fight here was over when to subtract that credit. Consumers Concrete left Central States in stages, 2017 and 2019, and the sequencing decides almost everything. Apply the credit early in the statute's four-step calculation, as the fund read it, and the company owes about $607,000 a year for twenty years ($9.3 million in present value). Apply it to the finished number, after the twenty-year payment cap, and the bill could reach zero. Judge Lee, joined by Judges Easterbrook and Ripple, held the credit comes off the finished number, expressly parting with the Eleventh Circuit (whose three judges each called it a hard case) and the Ninth. The PBGC filed an amicus brief supporting that reading, its position since 1985, and no Seventh Circuit judge asked to rehear the case. Employers and funds now face conflicting appellate answers to the same arithmetic, with the agency on the employer's side of the split.

Listen: The First Circuit’s Argument in the First Tobacco-Surcharge Appeal
Williams v. Bally’s Management Group, No. 25-2159, 1st Cir. 2026-09-16

The tobacco-surcharge wave's first appellate argument, recorded Wednesday morning in Boston, is posted. It runs forty minutes before Judges Rikelman, Kayatta and Aframe on whether ERISA's wellness rules required Bally's to refund surcharges to smokers who completed the cessation program. We covered the district court's November opinion when the wave began, and however the panel comes out, it will be the first appellate word on the theory behind at least five pending appeals. A decision is still to come. The audio is worth a commute.

Also Noteworthy (1)

Why Skipping Metabolic Health Is a $100k Mistake
Employee Benefit News · opinion 2026-09-16

Tammy Sun, founder and chief executive of the fertility-benefits provider Carrot, argues that fertility plans lean too quickly on IVF, which she puts at upwards of $30,000 a cycle, and skip what she calls the “premester,” the window before conception when metabolic care can shape whether IVF is needed at all. She notes the pending federal proposal to classify fertility coverage as an excepted benefit with a $120,000 lifetime cap, and contends a benefit built around procedures rather than root causes would spend that cap faster with worse outcomes.