BENEFITS DIGEST

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A publication of The Inner Firm

Thursday, October 1, 2026

№ 64

25 items · ~16 min read

Regulatory & Guidance (4)·Retirement Plans (5)·Health & Welfare (3)·Court Decisions & Case Commentary (11)·Also Noteworthy (2)

The One Thing

A list of therapists isn't much help if the people on it can't see you. Participants suing Blue Shield of California say its mental health directory included providers who were dead, retired, out of network, or not accepting patients. They say they paid out of pocket or went without care as a result. In a September 23 order, Judge William Orrick allowed their core claims against Blue Shield to proceed, including claims over denied benefits, misleading network information, and unequal treatment of mental health coverage. That isn't a finding that the allegations are true. It means the insurer must continue defending them. Employers have a practical question to ask their health plans: how do you check whether listed providers are actually available, and what help do members get when the calls lead nowhere?

Regulatory & Guidance (4)

Treasury and IRS Publish the 2026-2027 Priority Guidance Plan
Treasury and IRS · 2026-2027 Priority Guidance Plan, initial version 2026-09-29

Treasury and the IRS have released their annual list of 121 guidance projects. This year's list covers October 1, 2026, through September 30, 2027, matching the federal fiscal year for the first time. The benefits entries are familiar. Trump Accounts guidance anchors the budget-law implementation section. A single entry carries the SECURE 2.0 projects, covering the saver's match, student loan matching, long-term part-time employees, emergency savings accounts, and automatic enrollment. A planned update to retirement-plan error correction would add a new resolution system for IRAs. The deregulation section carries electronic-delivery rules for participant notices and elections, defined benefit funding regulations, and, as Groom notes, long-promised regulations for welfare benefit funds, including the tax-exempt trusts many employers use to fund health and welfare benefits, that have appeared on the list for years without a published rule. The list sets priorities, not deadlines.

CMS Opens the Book on Part D Pharmacy Contracting
CMS · request for information · 91 FR 60568 2026-09-24

CMS wants comments on what a fair pharmacy contract looks like. A new request for information begins implementing a 2026 budget law amendment that requires the Secretary to set reasonable and relevant standards for the contracts Part D plans and their pharmacy benefit managers offer pharmacies, standards due by April 2028 and applying to plan years starting January 1, 2029. The questions reach well beyond Medicare mechanics: whether pharmacies are paid more or less than drugs cost them to buy, pricing guarantees measured across all drugs rather than drug by drug, whether Medicare contracts subsidize PBMs' commercial business, discounts under the federal 340B drug pricing program, which drugs get labeled specialty drugs, and what happens when the PBM and the pharmacy share an owner. Employer plan sponsors have seen every one of those issues in their own PBM negotiations, and standards CMS writes for Part D have a way of becoming the reference point for the commercial market. Comments are due November 23, 2026.

IRS Postpones a Year of Deadlines for Taxpayers Affected by the Conflict in Israel
IRS · Notice 2026-63 · IR-2026-116 2026-09-30

The fourth round of Israel-related tax relief is the broadest yet. Acts due on or after September 30, 2026 and before September 30, 2027 are postponed to September 30, 2027 for affected taxpayers, a group that includes residents and businesses in Israel, the West Bank, and Gaza, relief workers assisting there, taxpayers whose return preparer or records are located there, and spouses on joint returns. The postponed acts sweep in making contributions to a qualified retirement plan, along with return filing, payment, Tax Court petitions, and refund claims, and acts already postponed under the three prior notices roll forward another year for taxpayers who remain eligible. The IRS applies the relief automatically to taxpayers whose address of record is in the covered area; others call the disaster hotline. Plan administrators with affected participants should flag the postponement, since a contribution that looks late on its face may be timely under the notice.

Trump Account Auto-Enrollment Proposal Lands in the Federal Register, Comments Due November 30
Treasury and IRS · proposed rule · 91 FR 61812 2026-10-01

The Trump Account auto-enrollment proposal has been published in the Federal Register. Comments are due November 30, 2026. The proposal would pair the temporary regulations' automatic account creation with rules for the claiming process and for qualified general contributions, and a scheduled October 15 public hearing on the related employer-contribution rules has been switched to telephonic only. The rules mainly concern how Treasury will create and administer the accounts. Jim Earle of Troutman Pepper Locke told SHRM the temporary and proposed rules don't directly affect employers or change the separately proposed rules for employer contributions. The comment window is the place to press questions about how claiming will work when employers start funding accounts.

Retirement Plans (5)

SEC Proposes Broader Access to Private-Market Investments
SEC · release 2026-96 · proposed amendments and requests for comment 2026-09-30

The SEC has joined the push to put private markets within reach of individual investors, and it said so in as many words. The Commission voted Wednesday to propose what it calls "responsible retailization": letting registered advisers charge performance-based compensation to regulated funds, modernizing interval funds, and giving closed-end funds a rules-based path to multiple share classes. Alongside the proposals, the Commission asks whether passing a FINRA-developed exam, or holding a CPA license, CFA charter, or CFP certification, should qualify someone as an accredited investor without meeting any income or net worth test. Chairman Paul Atkins tied the package directly to the President's executive order on alternative assets in 401(k) plans, calling it a complement aimed at post-tax dollars. The comment windows run 60 days from Federal Register publication, and they are where concerns about valuation, liquidity, and fees get raised.

The Letters Behind the 401(k) Comment-Fraud Referral Are Now Public
House Education and Workforce Committee Democrats · press release 2026-09-18

House and Senate Democrats have released letters asking the Justice Department and the FBI to investigate roughly 12,000 suspected fraudulent comments supporting the Labor Department's proposed safe harbor for alternative assets in 401(k) plans. The letters from Ranking Members Bobby Scott, Jamie Raskin, and Bernie Sanders, previously reported but only now posted in full, invoke the federal false statements statute. Scott and Sanders separately ask the department's Inspector General for an audit, and Scott urges Acting Secretary Sonderling to investigate and withdraw the rule. Wealth Management's coverage recounts the Bloomberg reporting behind the letters, including supportive comments attributed to people who had died.

Claiming Age Clarity Act Clears Congress, Renaming Social Security's Claiming Milestones
Congress · H.R. 5284 · passed Senate September 29 2026-09-30

The Senate passed the bipartisan Claiming Age Clarity Act by unanimous consent, sending it to the President. If signed, the bill would require the Social Security Administration to retire its claiming-age vocabulary: early eligibility age would become minimum monthly benefit age, full retirement age and normal retirement age would become standard monthly benefit age, and references to age 70 would carry the label maximum monthly benefit age, with the term delayed retirement credit dropped entirely. Sponsors Lloyd Smucker and Don Beyer argue the current labels nudge people toward claiming at 62 even though waiting can raise a monthly benefit by more than 75 percent. Plan sponsors and recordkeepers that echo Social Security terminology in retirement education materials may want to update their language to match.

Goldman Survey Finds the Strain Beneath Steady Participation
PLANSPONSOR · Goldman Sachs Asset Management 2026 retirement survey 2026-09-30

Housing costs, everyday expenses, and debt are making it harder for workers to increase their retirement savings. Goldman Sachs Asset Management's 2026 retirement survey, released Wednesday, finds the share of workers who increased their retirement savings fell to 39 percent from 55 percent a year ago, while the share who cut savings nearly doubled to 14 percent. The pressure points differ by generation, and 61 percent of surveyed workers report working outside their primary job, most of them out of financial need. Only 58 percent of savers call themselves on track, down from 68 percent last year. For sponsors, the survey argues for plan design that treats emergency savings, debt, and retirement as one connected problem rather than competing line items.

Benefits Administrator Pleads Guilty to Stealing $8.8 Million in Benefit Money
Department of Justice · press release · United States v. Campbell (D. Md.) 2026-09-29

James Vincent Campbell, founder and chief executive of Axim Fringe Solutions Group, a third-party administrator that processes benefits for federal contractors' employees, pleaded guilty to theft from an ERISA plan after admitting he converted more than $8.8 million that federal contractor clients sent the firm to cover employees' health premiums and 401(k) contributions. Court documents describe 135 unauthorized withdrawals totaling $2,486,905 from the master trust where client funds were pooled, plus fee overcharges of up to five times the correct amount after the firm moved from Maryland to Arizona, with the money spent on big game hunting trips, taxidermy, jewelry, gambling, and payments to his girlfriend. He faces up to five years in prison. PLANSPONSOR reports sentencing is set for January 2027. The case is a reminder that an administrator holding plan money in trust deserves the same diligence as any investment provider.

Health & Welfare (3)

White House Starts Mailing $500 ACA Refund Checks to Nearly 1 Million People
The Hill 2026-09-30

Treasury checks of $500 began going out Wednesday to more than 950,000 people in the 30 states that use the federal marketplace, money the administration describes as a refund of excess healthcare.gov user fees collected from insurers. Recipients are mostly enrollees who earn above 400 percent of the federal poverty level and lost premium help when the enhanced subsidies expired at the end of last year; people still receiving subsidies and residents of state-run exchanges are not eligible. The administration says the checks draw on a $500 million fund of user fees that ordinarily pays for call centers, technology, and enrollment outreach. No rule or formal notice accompanies the program so far; the account comes from an administration official and a letter from the President included with the checks. Employers fielding questions from part-time or former employees on marketplace coverage may want to know the checks are real.

What the New Tobacco Surcharge FAQs Settle, and What They Leave Open
International Foundation of Employee Benefit Plans · Word on Benefits 2026-09-29

The International Foundation walks plan administrators through the tri-agency FAQs on tobacco surcharges that responded to the wave of wellness-program class actions, underscoring the two points sponsors most often get sued over: a plan that pays the wellness reward prospectively once an employee completes a reasonable alternative standard doesn't owe the reward retroactively to the start of the year unless the program promises it, and the required notice of alternatives need not appear in every document that merely mentions the program. The piece also reads the FAQs as a signal that further wellness guidance may come. With surcharge suits still being filed, the practical move is a document sweep to make sure notice language is consistent everywhere the program is actually described.

Why the Seventh Circuit Let Arkansas Regulate PBM Pharmacy Pay
Mintz · Health Care Viewpoints · via JD Supra 2026-09-29

The Seventh Circuit upheld an Arkansas rule requiring pharmacy benefit managers to pay pharmacies fair and reasonable rates. Mintz explains why the court treated that payment rule differently from state laws governing pharmacy networks: the Sixth, Eighth, and Tenth Circuits have struck down laws that reached network design and preferred-pharmacy structures, while the Arkansas rule regulates only what pharmacies are paid. The court separately held that the data reporting needed to enforce a lawful payment rule does not run into federal limits on state reporting requirements. Self-funded plans operating nationally now face one more state PBM rule that courts have let stand.

Court Decisions & Case Commentary (11)

Blue Shield and Magellan Must Face Ghost-Network Claims
N.D. Cal. · Roiz v. Blue Shield of California · motion to dismiss, granted in part and denied in part 2026-09-23

Judge William Orrick allowed claims over denied benefits and failures to protect plan participants to proceed against both Blue Shield and its mental health subcontractor, Magellan. Blue Shield also faces a claim that its mental health network offered worse access than its medical network. For employees in plans outside ERISA, the court allowed claims to enforce their employers' contracts with Blue Shield. Magellan won dismissal of several state-law claims on different grounds, including that participants couldn't enforce its contract with Blue Shield. The plaintiffs can revise the dismissed claims. The ruling allows the surviving claims to move forward; it doesn't establish that either company broke the law.

No Private Lawsuit to Collect an Unpaid Surprise-Billing Award, California Court Holds
N.D. Cal. · California Spine and Neurosurgery Institute v. Microsoft Welfare Plan · dismissal 2026-09-23

A surgery center that won a $71,888.85 arbitration award under the No Surprises Act and never got paid can't sue to collect it, Magistrate Judge Nathanael Cousins held, dismissing every claim without leave to amend. The court found no private right of action to enforce independent dispute resolution awards, agreeing with the Fifth Circuit's Guardian Flight decision and with the Second Circuit's September ECAPS ruling: enforcement belongs to the agencies through penalties, not to providers through lawsuits. The provider's fallback ERISA claims failed for lack of standing because the patient, fully insulated from the unpaid balance, suffered no injury the assignment could carry. State law claims could not fill the gap. The upshot of this ruling is specific: the provider holds an arbitration award the plan hasn't paid, and this court closed every route it offered for collecting it.

Court Reverses UnitedHealthcare on Pandemic-Era Emergency Care
W.D. Ark. · Saucedo v. UnitedHealthcare · judgment for participant 2026-09-21

Chief Judge Timothy Brooks declined a magistrate's recommendation and entered judgment for a participant, holding that UnitedHealthcare abused its discretion when it refused to classify oral surgery after an accident as emergency care because the surgery happened more than a week after the injury, in May 2020, when pandemic restrictions delayed treatment. The plan's own pandemic provision and its promise that the initial emergency visit will be covered could not be read, the court held, to mean only the initial visit, when emergency room doctors had documented the need for immediate surgery. The classification left the participant with $33,827 in out-of-pocket costs for pre-operative services and $73,068 for the surgery, and the court ordered the services covered in network, with a fee motion pending. Administrators holding discretion clauses should note the lesson: discretion exercised against the plan's own words, in circumstances the plan itself anticipated, doesn't survive review.

Rithm Must Face Claims Over Its Handling of Forfeited 401(k) Money
N.D. Tex. · Cortez v. Rithm Capital · motion to dismiss, granted in part and denied in part 2026-09-22

A federal judge dismissed some claims over Rithm Capital's use of forfeited 401(k) money, the amounts left behind when employees leave before earning full ownership of employer contributions, but allowed others to proceed. Judge Ed Kinkeade dismissed the duty of loyalty claim, adopting the majority view that a fiduciary exercising discretion the plan grants over forfeiture allocation doesn't thereby breach loyalty, and threw out the prohibited transaction counts for failure to plead any transaction. But the prudence claim survived on allegations that forfeitures sat unallocated at year end under a flawed process, and a claim that plan assets were improperly used for the employer's benefit survived alongside it, a combination few of these plaintiffs have achieved. The plaintiffs have 14 days to revise the dismissed claims.

Legacy Health Wins the First Round of Its Forfeiture and Stable-Value Suit
D. Or. · Foley v. Legacy Health · motion to dismiss granted, leave to amend 2026-09-30

A federal judge dismissed the amended retirement-plan complaint against Legacy Health, its board, and its retirement committee. The plaintiffs have 30 days to try again. Judge Adrienne Nelson found the stable-value claims failed for want of a meaningful benchmark: none of the 13 comparator funds was alleged to be the same kind of guaranteed investment contract, and the court held the Ninth Circuit's approach to comparing investment funds, now under Supreme Court review in Anderson and set for argument October 6, applies to stable-value challenges too. A T. Rowe Price growth fund claim failed because underperformance against one benchmark, standing alone, doesn't plead imprudence. On forfeitures, the court joined the majority view that applying forfeitures to employer contributions, as the plan expressly permitted, is neither disloyal nor imprudent without more, found the anti-inurement claim failed because the money never left the plan, and noted the Ninth Circuit's pending Hutchins appeal on the same question.

Cognizant Agrees to Pay $2.8 Million to End Its Six-Year 401(k) Fee Suit
D.N.J. · Milano v. Cognizant Technology Solutions U.S. Corp. · unopposed motion for preliminary approval 2026-09-29

Cognizant has agreed to a $2.8 million settlement of a 401(k) lawsuit filed in December 2020. Participants alleged excessive recordkeeping fees and poorly performing investment options. The court hasn't ruled on the merits, and the settlement still needs approval. The deal came out of mediation, with both sides accepting the mediator's proposal in June. Plaintiffs' counsel values it at about 21 percent of a $13.4 million best-case recovery; attorney fees of up to a third of the fund, $150,000 in expenses, and $10,000 awards for each of the five named plaintiffs would come out of it. The settlement class, roughly 40,000 participants at its peak year, wouldn't be allowed to opt out under the proposed settlement.

Employer Must Face Claim Over the Life Insurance Offer It Never Relayed
D.N.M. · Vigil v. Taos Ski Valley · judgment on the pleadings denied 2026-09-25

After an employee died, his life insurer offered to reinstate his lapsed coverage if about $1,300 in back premiums were paid. His widow alleges that Taos Ski Valley declined the offer without telling her, and that she would have paid the premiums herself to preserve the $95,000 policy. Judge Kea Riggs allowed her claim seeking the lost insurance benefits to proceed, holding that ERISA's equitable remedies provision permits make-whole monetary relief against a fiduciary for this kind of breach, and that the remedy doesn't require tracing the money to any particular fund. The ruling decides only that the claim may go forward; an earlier theory failed against documents showing the employer answered a 2023 inquiry promptly. Roberts Disability Law's analysis flags the duty at the center: a fiduciary must share material information about coverage with the people it affects, even when no one asks.

EEOC Says Scheels Forced Older Workers to Sell Their Company Stock
EEOC · press release · EEOC v. Scheels All Sports (D. Nev.) 2026-09-30

The EEOC has sued Scheels All Sports, the employee-owned sporting goods retailer, alleging its employee stock ownership plan discriminated by age. Under the policy the agency describes, employees 40 and over who didn't work 1,000 hours in a year were forced to sell their company shares, while employees under 40 who worked the same reduced hours kept theirs, a design the complaint attributes to stereotypes about which workers are worth retaining. The charging party, a 20-year employee in Reno, was required to divest after turning 40 and ultimately resigned. The suit pleads the Age Discrimination in Employment Act rather than ERISA, a reminder that benefit plan design answers to more than one statute. These are allegations in a complaint the agency filed after conciliation failed, and the company hasn't yet responded. Sponsors with hour-based or age-based distinctions in equity and retirement programs should look at which lines their plans draw and why.

What Courts Now Do With Bostock When the Benefit Is Fertility Coverage
HR Dive 2026-09-30

HR Dive explains the Kulwicki fertility-benefits ruling in plain terms: under the Supreme Court's Bostock decision, the court flipped exactly one variable, the plaintiff's sex, and asked whether the benefit would treat a hypothetical male employee better. Because the plan covered no male infertility treatment at all, the comparison failed, and with it the claim that the plan's eligibility terms discriminated by sexual orientation. Both sides agreed that Bostock applied. They disagreed about how to make the comparison.

Marsh Suit Challenges Commissions on Employees' Voluntary Benefits
NAPA Net 2026-09-30

NAPA's Nevin Adams walks through the Marsh & McLennan voluntary benefits complaint as the third in Capozzi Adler's series, after USI and Arthur J. Gallagher, and lays out the arrangement the three complaints allege: the employer sits on both sides of the transaction as plan sponsor and broker, specifies its own commission and administration fee structure, and the carrier builds that compensation into the premiums participants pay, so that when the broker demands more, participants pay more. The piece also traces the two safe harbor prongs the suits attack, endorsement through company-branded benefits handbooks and the nearly $7 million in consideration Marsh allegedly retained. The allegations haven't been tested, and any employer whose affiliates earn revenue from its own benefit plans will want to understand the theory.

The Benefits Bar Reads the AT&T and State Street Pension-Transfer Split
PLANSPONSOR 2026-09-30

The AT&T pension-transfer ruling puts the focus on who selected the insurer and how that decision was monitored. AT&T is out of the case because it delegated the Athene selection and knew of no red flags, while State Street stays in because it made the choice. Kent Mason of Davis & Harman calls the decision to let the case proceed at all "just wrong," arguing the court misread the Supreme Court's limits on participants' ability to sue and blessed insurer comparisons it conceded might not hold. Jordan Mamorsky of the Wagner Law Group draws the sponsor lesson, that delegating to an independent fiduciary shifts the fight to whether monitoring missed red flags. The piece also cites a litigation tracker kept by Mason's firm: 13 pension risk transfer suits filed since 2024, none in 2026, with the Labor Department now filing briefs on the sponsors' side.

Also Noteworthy (2)

Voting Leave Laws Deserve a Look Before November 3
Ogletree Deakins 2026-09-30

Election Day is November 3, and 28 states plus the District of Columbia require time off to vote, paid in some states and unpaid in others, with early voting starting mid-October in many of them. The variation is the trap for multistate employers: Colorado now mandates up to two hours of paid leave on any day polling centers are open, Maryland requires two paid hours only when an employee lacks two consecutive off-duty hours while polls are open, and California bars employers from asking employees to bring mail ballots to work. Several states add posting requirements and advance-request rules, and some extend leave to employees serving as election officials. The practical moves are handbook supplements by state, manager training on how to handle requests, and staffing plans for operations that run around the clock.

Retiree Buyouts Hover at 99.9 Percent of Accounting Liability
Milliman · Pension Buyout Index · August 2026 data 2026-09-30

Milliman's monthly index puts the estimated competitive cost of buying insurance contracts to pay retirees' pensions at 99.9 percent of the liability on the sponsor's books as of August 31, up 0.2 percentage point from July, while the average across all participating insurers eased to 102.9 percent. The gap between those two numbers is the argument for competitive bidding, which Milliman estimates saves sponsors about 3 percent. Actual pricing will depend on the plan and its retirees, and employers still need to assess the insurer carefully.