BENEFITS DIGEST

The fourth quarter calendar for health and welfare sponsors, in one place. October 2 brings QSEHRA and ICHRA notices and Medicare Part D subsidy applications; October 15, creditable coverage notices and extended Form 5500s; December 15, summary annual reports for extension filers; December 29, the employer share of MLR rebates within 90 days of receipt; December 31, gag clause attestations plus WHCRA and Section 1557 notices. A companion checklist covers open enrollment materials—SBCs, Michelle's Law, HIPAA notices, wellness alternative standard disclosures—and the state assessments landing this quarter, from Massachusetts payor assessments to Washington's long term care tax.

A rename, not a rulemaking: on September 3 the Small Business Administration and CMS announced that individual coverage HRAs will now go by CHOICE Arrangements, borrowing the branding from provisions of two House-passed bills that never survived final passage. Nothing structural changes—employers still reimburse individual market or Medicare coverage under the 2019 tri-agency framework—but the administration is signaling more rulemaking ahead, exploring flexibilities to boost adoption that has run well behind the original 800,000-employer projection. CMS has a new landing page for whatever comes next.

Segal's read of the section 129 proposed regulations puts the testing mechanics up front: the eligibility test pairs a reasonable-classification standard with a numerical safe harbor, no more than a quarter of total benefits may flow to five percent owners, and average benefits for the non-highly compensated must reach 55 percent of the HCE average, counting only employees who actually use the program. The correction path may matter most in practice. Certain failures can be cured by reporting excess benefits as taxable income on the affected W-2s by the deadline. Sponsors may rely on the proposed rules now; comments close September 25.

Health plan governance is getting the 401(k) treatment. Benefits attorneys and consultants walk through what sponsors should be doing now: negotiate rebate pass-throughs and oversight rights into PBM contracts before signing, benchmark per-member fees, and collect compensation disclosures from every vendor taking $1,000 or more a year from the plan. The clock behind the advice is the Consolidated Appropriations Act of 2026. Its ERISA-fiduciary provisions treat PBMs as covered service providers and require spread pricing out of contracts by August 1, 2029.

The DOL released Field Assistance Bulletin 2026-03 this week with a companion web page that reads like an examiner's checklist, and Seyfarth turns both into a working roadmap. Enforcement will concentrate on three areas: blanket treatment exclusions, where residential eating disorder care and ABA therapy for autism are the named examples; medical necessity and utilization management; and network adequacy and provider reimbursement. Worth underlining: the nonenforcement relief for contested pieces of the 2024 final rule, which the agency is reworking through new rulemaking, changes nothing about the statutory comparative analysis obligation for NQTLs. Since vendors hold most of the data these reviews require, the guidance doubles as leverage for negotiating that support into service agreements.

The IDR machinery gets some plumbing: federal agencies released nine new remittance advice remark codes so payers can tell providers exactly why a claim is not surprise-billing material—a state law limits the reimbursement, the claim is ineligible for IDR, the service is not covered. The codes supplement the existing claim adjustment reason codes and become mandatory January 1, 2027. Small as it sounds, clearer remittance coding aims at the front end of the dispute pipeline, where miscommunication feeds the arbitration volumes the agencies have been trying to tame all year.

Mayer Brown's read of the wellness program FAQs is organized around the five conditions an outcome based program must satisfy, from the annual qualification opportunity to the 30 percent reward cap that rises to 50 for tobacco programs. Two clarifications do the practical work. Completing a reasonable alternative mid-year earns the reward only prospectively—a June cessation course does not refund the January through May surcharges. And materials that merely note costs vary with participation do not trigger the full disclosure package, while anything describing the actual standards must include the alternatives and the physician accommodation statement.

Claims data confirming what benefits teams have suspected: in the group commercial population from 2022 through 2024, only about a quarter of women ages 40 to 64 carried a menopause diagnosis, and treatment often ran misaligned with documentation—therapy without a recorded diagnosis, diagnoses without corresponding care. Women with documented menopause showed higher rates of selected comorbid conditions, which is why the underdiagnosis matters for plan spend as much as for outcomes.

An argument that menopause is a benefits design problem, not an awareness problem: $1.8 billion a year in lost productivity, roughly 6,000 U.S. women reaching menopause daily, and a Mayo Clinic finding that 13 percent experienced an adverse work outcome from symptoms. With the FDA's removal of the warning that long discouraged hormone therapy now driving demand—and a shortage of estrogen patches—direct to consumer vendors are rushing into the gap, some initiating hormone therapy without a physical exam or mammogram. The prescription is integrated primary care built into the plan rather than point solutions, with Rhode Island's first-in-the-nation menopause accommodation mandate a sign of where this is heading.

The opener of a three-part KFF video essay series on where the premium dollar actually goes, and the answer is mostly upstream of the insurer. National health spending reached $5.3 trillion in 2024, and hospitals alone have driven 40 percent of the growth in recent years, and one or two health systems controlled inpatient care in nearly half of U.S. metro areas. Insurers largely pass those costs through, and consolidation plus employers' own demands for broad networks leave them little negotiating leverage.

Part two puts numbers on the insurer's share: overhead and profit run about $846 per enrollee per year in the employer market, $987 in the individual market, and $1,655 in Medicare Advantage—where roughly a dime of every premium dollar stays with the plan, against under two cents of administrative cost in traditional Medicare. Margins are thin in percentage terms, but the seven largest publicly traded insurers, PBM subsidiaries included, earned an estimated $71 billion in 2024. The question posed is not whether they profit but what value comes back.

The closer lands on the tradeoff sponsors live with daily: someone has to decide what gets covered and paid, and KFF's polling finds prior authorization is the single biggest burden insured adults report beyond cost itself, with nearly half saying care was denied or delayed within two years. On price, private insurers pay roughly double what Medicare pays for hospital care. Utilization management controls spending and blocks care clinicians call necessary; the series declines to pretend there is a clean answer.

Aon's compliance and policy consulting team reads the FAQs against the tobacco surcharge litigation that produced them. The sharpest points come in the comments—that the 2013 preamble suggested retroactive rewards while the regulatory text never clearly imposed them, and that the enforcement position may reduce regulatory audit risk but does not eliminate litigation risk, since some courts have already agreed with retroactive full reward claims. A closing caution tells plans not to read the disclosure clarification as a reason to drop model reasonable alternative standard language from participant materials.

A walk through the late August FAQs confirming that a plan does not owe a tobacco surcharge refund back to the start of the plan year when a participant meets a reasonable alternative standard midyear. The Departments concede the 2013 regulatory text never clearly required retroactive application and promise no enforcement action against plans that pay the reward prospectively, while stopping short of amending the rule itself.

Bass Berry focuses on where the relief runs out. The FAQs bless prospective-only rewards and confirm that a passing reference to a wellness program in a benefits summary does not trigger the full disclosure obligation, but the forbearance binds only the agencies. Disclosure failures, fiduciary breaches, and plan design defects remain open theories for private plaintiffs.

The angle here is the notice mechanics. The reasonable alternative standard disclosure belongs in every plan material that describes a health contingent program's terms, and for outcome based programs it must also appear in the communication telling an individual they failed the initial standard. A summary of benefits that merely notes cost sharing can vary with wellness participation does not trigger the duty. The piece also stresses that the relief is temporary, pending future guidance.

The summary aims at HR execution. Beyond the headline relief on retroactive rewards, it restates the ground rules: outcome based programs need a reasonable alternative standard, rewards cap at 30 percent of employee only cost with 50 percent for tobacco programs, and materials describing the program must disclose the alternative and the physician accommodation. It closes with three action items—confirm the tax treatment of rewards, evaluate whether the program actually works, and train HR staff to handle alternative standard requests.

Seyfarth finds the practical wins in the proposed Section 129 regulations. The average benefits test now counts only employees who actually receive DCAP benefits, which should make the 55 percent threshold easier to satisfy, and salary reduction arrangements may disregard employees earning under $25,000. A new correction mechanism lets an employer cure a failed average benefits or owner concentration test by moving the excess into affected individuals' W-2 income, preserving tax favored treatment for everyone else. Comments close September 25 with an October 15 hearing, and employers may rely on the proposal now.

The 2026 Aegis Risk survey of 1,378 plan sponsors covering 1.4 million employees finds stop-loss renewal increases running from 13.6 percent at a $100,000 deductible to 15.9 percent at $750,000, roughly five points above last year's increases. The survey attributes the correction to late 2024 claim severity and leveraged trend against unchanged deductibles, and sees no easing in the 2027 cycle.

Representative Frank Pallone sent oversight letters to six IDR entities—C2C Innovative Solutions, Commence, Dane Street, EdiPhy Advisors, National Medical Reviews, and ProPeer Resources—with responses due September 24. He wants to know how they decide disputes, how often they rule claims ineligible, how frequently providers win, and how their decision makers are paid. The context is stark: a system built for 17,000 cases a year took in 2.5 million disputes in 2025, Georgetown research puts the added spending at $22 billion over four years, and two of the six rule for providers more than 90 percent of the time.

The tri-agencies announced a recertification process for the IDR entities that decide No Surprises Act disputes, testing rationale quality, capacity to keep up with volume, and conflicts of interest, with each entity's renewal subject to a five day public petition window in which plans and employers can object. An entity that fails to renew must refund fees on its pending disputes. One framing data point: a median in network rate of $86 for an hour of hospital observation time against a median IDR award of $19,985 for the same hour.

Lockton's third quarter market update names four pressures keeping costs elevated: expensive medications, accumulating high cost claims, chronic condition management, and rising utilization. On the pharmacy side it calls out double digit brand drug price increases and growing GLP-1 spend. The update pairs a five step checklist for managing increases with a look at leave administration complexity.

Turquoise Health dashboard data for the second quarter of 2025 shows UnitedHealth winning 67.7 percent of the disputes it initiated, though that is 21 wins across just 31 claims. The fuller picture runs the other way, providers file the overwhelming majority of disputes and win at roughly 80 percent, with one provider side firm resolving 341,866 claims at an 88.4 percent success rate.

Written for self insured organizations, large deductible programs, and captives, the point is that a reserve increase is not by itself bad news. Three complementary diagnostics—actual versus expected development, a reserve walk between evaluation dates, and frequency and severity analysis—turn the periodic reserve review into a tool for spotting emerging trends and supporting funding decisions.

The sources converge on one design principle—keep a human in the loop and make access to a counselor a standing choice rather than an escalation. Gallagher's Robby White urges advisers to steer employers toward communications, decision support, and navigation first, inside a governance framework that is transparent about what data the tools use. Collective Health's Ali Diab says autonomous agents making healthcare decisions are not here yet, though the direction is set.

The Labor Department's Veterans' Employment and Training Service issued an opinion letter reading the 2025 amendment that added other retaliatory action to USERRA as aligning the statute with Title VII retaliation standards. The examples go well beyond firing, schedule changes, transfers to less desirable positions, increased scrutiny, exclusion from professional opportunities, and threats all qualify when they would dissuade a reasonable worker from asserting rights—agency guidance rather than a decided case.

The alert uses Ohio's Senate Bill 396, which would create a state paid family and medical leave insurance program, to restate the multi-state math. Fourteen states plus D.C. already run mandatory programs, Maryland contributions start in January 2027 with benefits in 2028, and obligations generally follow work location, so a single remote hire in a PFML state can pull an employer in. It also flags the recurring mistake: assuming an existing PTO policy satisfies a state program that actually works like unemployment insurance with its own contributions and notices.

Segal walks through the federal IDR overhaul's next two operational steps under the No Surprises Act. Registration for the IDR Gateway, the centralized platform replacing one-off web forms, opens September 15, and sponsors who rely on a TPA need no account of their own but should confirm the TPA has registered. New batching rules take effect November 1. Up to 50 items or services may travel in one dispute if furnished within the same 30 business day window and tied to a single patient encounter or the same or comparable service code, and a batched determination now triggers a 30 business day cooling off period before the initiating party may open a new dispute over the same item or service.

Robert Andrews, the former congressman who leads the Health Transformation Alliance, tells EBN the question for employers is not how much they spent but what they got for the money. With nearly all employers covering GLP-1s for diabetes, the hard decision is obesity coverage for patients who are not diabetic, and Andrews describes a turn toward clinically driven coverage decisions built on claims and health record data, watching whether weight stays off and A1C improves. Before cutting benefits, he argues, employers should chase the waste first, the billing errors, ineligible claims, and payments that should never have gone out the door.

Greenberg Traurig recaps New York City's amended safe and sick leave rules, under city guidance issued July 23 following February's legislative changes. Employers must front load 32 hours of unpaid leave for nearly all employees, provide 20 hours of paid prenatal leave running on 52 week cycles rather than calendar years, and keep substantially expanded records, including prior policy versions and per pay period balance tracking. Penalties start at $500 per employee per instance and escalate from there.

Forty-five years after Section 129 joined the Code, the IRS has proposed the first regulations on dependent care assistance program nondiscrimination testing. Seyfarth walks through all four statutory tests, each receiving detailed guidance for the first time, including a ratio-percentage safe harbor for the eligibility test and an average benefits calculation that counts only employees who actually receive benefits, a change that may make the test easier to pass for employers who have struggled with it. A new correction mechanism lets a failing plan preserve tax-favored treatment by moving excess benefits into affected individuals' taxable income by the W-2 deadline. Comments are due September 25, a public hearing is set for October 15, and employers may rely on the proposal now.

Marsh's national survey of more than 1,800 employers projects health benefit costs rising 8.2% in 2027, the sharpest annual jump since 2003, and 11% for employers who take no action. Some 59% plan cost-reduction moves such as raising deductibles, and GLP-1 coverage alone accounts for about a percentage point of the increase.

An opinion piece from the founder of Empower Healthcare Insights argues that moving beyond traditional healthcare options opens the door to a better experience for employers and employees alike.

Mayer Brown reads the August 26 FAQs as a reversal of the Labor Department's own prior litigation positions on retroactive wellness rewards, with plans now required only to provide the reward for the period after a reasonable alternative standard is satisfied. The firm also explains the disclosure rules in plain terms. If plan materials only mention that a wellness program exists, nothing more is required, but once materials describe how the program works they must also explain the alternative standard and the option to follow a doctor's recommendations. Mayer Brown recommends auditing participant-facing materials against the new standard.

With employer health costs expected to jump 11.1% in 2027 by WTW's count, finance chiefs are moving into territory HR used to own. WTW's Tim Stawicki says employers are mostly avoiding drastic benefit cuts and instead scrutinizing vendors, hunting fraud and waste, steering employees to lower-cost providers, and looking at spousal surcharges and waiting periods. Big employers have largely locked their 2027 strategies; midmarket companies are deciding now.

Seyfarth focuses on where the alternative-standard notice has to appear. Any plan material that describes how a wellness program works must include it, and for outcome-based programs it must also show up in the message telling an employee they failed the initial test, with contact information for requesting the alternative. The enforcement relief changes none of these design requirements.

Bradley's version adds a concrete example on the notice question. If your summary of benefits and coverage says cost sharing may vary based on a wellness program but does not describe how the program works, that alone does not trigger the obligation to disclose the reasonable alternative standard. A useful line to hand whoever drafts your enrollment materials.

Squire Patton Boggs adds two practical details to the FAQs Part 74 coverage. The enforcement relief means an employee who completes tobacco cessation counseling in June need not be refunded surcharges for January through May, and plan materials that merely mention a wellness program's existence, without describing its terms, do not trigger the obligation to disclose reasonable alternative standards.

Bricker tells the story of how we got here. A stray phrase in the 2013 regulations' preamble suggested employees who quit smoking mid-year had to get their surcharges refunded back to January, a reading plaintiffs' lawyers ran with. The new FAQs say prospective relief is enough, no refunds required. But the program still has to be reasonably designed with a properly disclosed alternative standard, so this is relief from one theory, not from the lawsuits.

HaloMD claims the No Surprises Act has cut out-of-network emergency spending by 13% to 52%, saving $1 billion to $4 billion a year. Independent researchers are skeptical. The study leans on assumptions rather than actual payment data, ignores the cost of running the arbitration system, and comes from a company that files about a quarter of all arbitration claims itself. Worth knowing before this number shows up in a policy fight.

New projections released this week put next year's employer health benefit cost increase at the highest level in more than two decades, adding pressure on plan sponsors heading into 2027 renewals and budget season.

A reminder that the July 23 proposed rule extending a notice-and-access electronic delivery safe harbor to ERISA group health plans is open for comment through September 21. The proposal mirrors the 2020 retirement-plan safe harbor but is website-only, with no direct email option, reflecting HIPAA privacy concerns, and it preserves unlimited free paper copies and a full opt-out for participants.

Lockton reviews the tri-agency FAQs Part 74 non-enforcement position, under which the Departments will not act against health-contingent wellness programs that pay the full reward prospectively once a participant completes a reasonable alternative standard, rather than retroactively to the start of the plan year. The piece cautions that FAQ guidance does not bind courts and the surcharge class actions continue, so plans already paying retroactive rewards may want to stay the course.

Segal's reference table adds the 2026 employer shared responsibility penalty amounts, the 2026 affordability percentage, and the federal poverty line safe harbor for plan years beginning January 1, 2026, a practical one-stop update for ACA compliance planning.

MetLife's president of U.S. business makes the case that improving employees' benefits literacy leads to smarter choices for their health and financial wellness, an argument for personalized decision support as employers look for ways to get more from every premium dollar.

UnitedHealthcare published the list of roughly 1,700 codes that will no longer require preapproval starting in October, part of its pledge to cull 30% of its utilization management controls. The codes span a broad range of services, and plan sponsors should expect the change to surface in network and claims conversations this fall.

An opinion piece argues that benefit advisers, who spend most of their time on medical trend, pharmacy costs, and renewals, should treat leave strategy as core advisory work rather than a topic to hand off, given how much absence management now shapes the employer benefits conversation.

Attorneys from McDermott Will & Schulte review the costs, benefits and risks for employers to evaluate when deciding how their benefits address these popular medications.

In late July, the Department of Labor proposed new regulations that would extend the notice-and-access electronic disclosure model that the DOL finalized in 2020 for retirement plans to group health plans.

Differences between physical and mental health services mean ensuring equal care 'in spaces that can be quite different.'

The Departments of Labor, Treasury, and Health and Human Services have issued new joint guidance in the form of FAQs offering some enforcement relief for employer-sponsored wellness programs.

Leveraging pharmacies for medical care and incentivizing employees to seek preventive care are among the ways plan sponsors are trying to keep cost hikes in check.

The agencies will not take enforcement action against plans that apply a tobacco surcharge reward prospectively once an employee satisfies a reasonable alternative standard, so employers need not refund amounts already collected. Bricker Graydon cautions that the relief is enforcement discretion, not a safe harbor. Programs must still be reasonably designed, properly documented, and disclosed, and the guidance does not resolve the private class actions already in the courts.

ERIC's read of the Georgetown research puts No Surprises Act arbitration costs at $22.4 billion over four years, with filings up 77 percent year over year and providers winning roughly 85 percent of disputes at awards well above median in-network rates. The employer lobby wants Congress to recalibrate the IDR process, arguing plans and workers ultimately absorb the pressure.

A deal between rival drug middlemen Prime Therapeutics and Express Scripts depressed reimbursement rates for pharmacies, according to the new complaint. It is the latest legal challenge against the partnership.

A self-funded group health plan is generally a HIPAA covered entity, while the third-party administrator that processes its claims is a business associate. Constangy walks through what the distinction means for the compliance obligations on each side.

While the legislation's future is still unclear, there are many important things for leaders to know.

Employers project base merit increases of 3.2 percent and total salary increases of 3.5 percent for 2027, in line with recent years, while employees' average healthcare contribution climbs 7.9 percent to $5,297. Only 13 percent of organizations had finalized 2027 salary budgets as of July.

Today's complex stressors require clearer access pathways and a company-wide commitment to mental health support.

The contribution mandate of Maryland's Family and Medical Leave Insurance program will soon take effect, and unionized employers face a potential labor relations challenge that requires immediate attention.

The U.S. Department of Labor has drafted a regulation designed to facilitate employers' use of electronic delivery systems as the default option when dealing with the Employee Benefits Security Administration and other federal agencies.

The July 23 proposed rule would give group health plan administrators an additional safe harbor for electronically furnishing required disclosures to participants and beneficiaries.

How Texas HB 198 and HB 4144 affect municipalities, first responder health benefits, cancer screenings, and retiree illness protection.

Childcare issues are putting pressure on working parents and employers alike. What benefit leaders should know about costs, tax credits and care.

Employers face another steep rise in healthcare expenses in 2027, prompting a closer look at GLP-1 coverage, pharmacy spending and high-cost conditions.

Researchers estimate that independent dispute resolution has created $22 billion in unnecessary spending. But that estimate is flawed, argue associations representing anesthesiologists, radiologists and ER doctors.

Groom situates the new tri-agency FAQ relief against the litigation wave that produced it: by the firm's count, the HIPAA wellness program rules have drawn more than 80 putative class actions claiming that premium surcharges for tobacco use violate ERISA. The relief addresses the midyear reward-timing and notice-disclosure questions; the broader surcharge fights, including the pending Sixth Circuit appeal in the Progressive case, remain in the courts.

New tri-agency FAQ guidance issued August 26 addresses elements of the 2013 wellness program regulations that have been the subject of dozens of class actions in recent years.

HR Dive rounds up practitioner reaction to the tri-agency wellness surcharge FAQs, with attorneys noting that aspects of ERISA once seen as settled continue to be challenged.

On July 22, 2026, the DOL issued a proposed rule with a new safe harbor allowing group health plan administrators to provide required ERISA documents to participants and beneficiaries electronically.

Employers are nearing double-digit health cost increases, but many won't be able to take drastic cost-cutting measures until 2028 at the earliest, the Business Group on Health's president and CEO told HR Dive.

Thompson Hine warns employers about double dip health plan arrangements marketed as payroll-tax savings vehicles. Treasury and the IRS have said repeatedly that these arrangements do not work under the law, and employers who adopt them risk liability for back taxes, penalties, and costly W-2 corrections.

The New Jersey Department of Labor and Workforce Development has issued new guidance confirming its position that employees who receive Temporary Disability Insurance or Family Leave Insurance benefits are entitled to job protection.

New proposed regulations make it easier for dependent care flexible spending accounts (“DCFSAs”) to pass applicable nondiscrimination rules under the Internal Revenue Code and, in particular, the “average benefits test.”

Employers are expecting a median 9.2% increase in medical spending next year, according to a new survey. But they’ve underestimated actual cost growth for the past three years, so even that figure may be too optimistic.

PSCA's annual Health Savings Account survey found 83% of eligible employees contributed to their HSAs in 2025, up from 73% a year earlier, while only about a quarter of employers actively position HSAs as part of a long-term retirement savings strategy. NAPA's read: participation is no longer the problem, and the open opportunity for employers is helping workers treat the accounts as more than a spending vehicle.

Accelerating dispute volumes and sky-high award amounts are inflating how much independent dispute resolution is costing the U.S., according to new Georgetown research. Patients could pay the price with higher premiums.

In Missouri, a new military leave law will take effect on August 28, 2026, impacting both public and private employers.

The federal Family and Medical Leave Act has long served as the primary framework governing employee leave, but an expanding patchwork of state paid family and medical leave laws now adds obligations that multistate employers must track alongside it.

On August 10, President Trump signed an executive order directing HHS to sort childhood vaccines into three tiers of recommendation within 90 days. Groom's read for plan sponsors: the order doesn't itself revise the CDC's ACIP-based immunization schedule, so the ACA's requirement that non-grandfathered group health plans cover ACIP-recommended immunizations without cost-sharing is unchanged for now. HHS's request for comment on the new framework runs through September 20.

Recent projections for 2027 increases range from 9.2% to 11% without plan-design changes.

PSCA survey finds more than 80% of employees contribute to their workplace Health Savings Accounts, but not enough workers are tapping their unique tax advantages.

For employer-sponsored group health plans, the impending change from global bundle to CPT-code billing for maternity care could bring better visibility while raising new questions about costs, administration and the participant experience.

Employers cover more than 80% of the burden, but employees will also be hit by rising costs, an Aon report found.

On July 22, 2026, the DOL published a proposed rule that would create a similar safe harbor for group health plans governed by ERISA that was adopted in 2020.

The 2026 regulations standardize claim communications, restructure open negotiation, clarify batching rules, and impose tighter deadlines for determining IDR eligibility. Self-funded plans must register.

From unexpected babies to "Ozempic teeth," the ultra-popular class of GLP-1 medications are turning out to have a few unanticipated side effects. Emerging research shows the drugs, which have proven effective in treating obesity and diabetes, may also be useful in treating addiction.

The city reduced the employment tenure requirement under its Paid Parental Leave Ordinance from 180 days to 90 days, meaning eligible employees can start accessing employer-paid supplemental compensation benefits faster.

HHS filed a request for information asking how federal vaccine recommendations should be categorized and what role shared clinical decision-making should play. We are tracking it because non-grandfathered group health plans must cover recommended immunizations without cost sharing under the ACA preventive services mandate, and the recommendation categories are the input to that requirement. This is an RFI, not a rule, so nothing changes for plan sponsors now; the question is whether it ripens into rulemaking that touches first-dollar coverage.

Nearly half of people with an ongoing mental health condition who use large language models say they lean on AI for mental health support, per a survey EBN reports, most commonly for anxiety and depression. For benefit leaders weighing AI tools in workforce mental health programs, the vetting question is no longer hypothetical.

A new risk analysis released by leading insurance broker Aon this week projected that employer health costs in the U.S. will rise by roughly 10 percent in 2027.

Another firm read on the DOL's proposed e-delivery safe harbor for group health plans: who counts as covered, the notice mechanics, and how the proposal extends the 2020 retirement-plan framework to the health side.

Gap coverage, supplemental benefits and options for various types of workers can help avoid cost shifting and still provide support.

Medical and pharmacy trends remain high at 7.7% overall. Learn what's driving healthcare costs and what employers should expect moving forward.

After years of arguing over what GLP-1 coverage should cost, employers are starting to ask the harder question: whether it is paying off. EBN on the early return-on-investment evidence and how benefit teams are measuring it.

A new executive order puts childhood vaccine policy back in the spotlight, but an executive order does not itself change the law, employer health plan coverage, or school vaccination requirements. Dr. Andy Halpert and attorney Katharine Marshall break down what the order does and does not do, and what employers should actually be watching as federal vaccine recommendations shift.

Employers that provide a Dependent Care Assistance Program will be pleased to learn that for the first time in 45 years, the IRS has issued guidance on how to apply the nondiscrimination rules that apply to DCAPs.

We describe how employer-sponsored health plans can use audits of their pharmacy benefit managers to identify operational and performance issues and help control drug cost expenditures.

Dependent Care Assistance Programs are subject to the nondiscrimination rules that are set forth in Internal Revenue Code Section 129 (Section 129).

Mercer reads the August 11 proposed regulations the way plan sponsors will experience them: testing requirements for dependent care FSAs get easier to satisfy, and employers may rely on the proposed rules immediately.

Aon's Compliance and Policy Consulting team digs into the DCAP half of the August 11 proposed regulations: clarified nondiscrimination testing that should raise passing rates, especially on the average benefits test, where only employees actually contributing are counted and workers earning under $25,000 may be excluded. Employers may rely on the proposed rules for 2026 plan-year testing now. Comments are due September 25, with a public hearing set for October 15.

The number behind the EBRI release covered here Wednesday: average HSA balances hit a record $5,532, while just 18 percent of accountholders invest any assets outside cash.

PLANSPONSOR's angle on the same EBRI study: HSAs are being used as spending accounts, with only 18 percent of participants investing beyond cash.

Groom walks through the DOL's proposed e-delivery safe harbor for group health plans: who counts as a covered individual, the notice-of-internet-availability mechanics, and where the proposal diverges from the 2020 retirement-plan framework. Comments are due September 21.

Average HSA balances hit a record high, but EBRI finds most account holders still contribute well below the maximum and few invest beyond cash. The accounts are growing as savings vehicles faster than they are maturing as investment vehicles.

Ogletree's filing guide for Maryland employers electing a private FAMLI plan instead of the state program: the declaration of intent, what to file, and when.

The companion piece: Maryland DOL released new employer resources ahead of the FAMLI program's first deadlines, and Ogletree rounds up what is there.

Illinois amended its Human Rights Act on August 7 to establish workplace protections for employees experiencing menopause-related conditions, effective January 1, 2027, and reaching employers with a single Illinois employee. Littler on the compliance build-out between now and the effective date.

Jackson Lewis on the same statute from the accommodation side: Illinois joins Rhode Island and Philadelphia in making menopause-related conditions a protected status, and employers should review handbooks, leave policies, and benefit designs before the January effective date.

The benefits-design case: menopause-related productivity loss costs U.S. employers an estimated $1.8 billion annually while only 18 percent treat it as a material benefits issue. The new state laws will force the gap onto agendas.

Under pressure to stay competitive while controlling costs, employers are turning new scrutiny on PBM contracts, hospital prices, and GLP-1 coverage heading into 2027 planning.

Mercer's quarterly state survey: Virginia enacted both paid family and medical leave and paid sick and safe leave, several states passed major PBM laws including a Tennessee statute challenged in court the day it took effect, and Alabama, Georgia, and Texas legislated on AI use in benefits.

A practical roundup of the coverage decision every health plan is facing: GLP-1 demand keeps climbing, the costs are reshaping budgets, and experts weigh the alternatives benefit leaders are actually considering.

Employers name high drug prices, high-cost claims, and hospital prices as their biggest affordability threats, and most say healthcare inflation is now eating directly into salary budgets. The compensation-side echo of the 10 percent trend number IFEBP put up last week.

The Fourth Circuit held an employee could pursue a failure-to-accommodate claim where he asked to be moved to open positions and was instead parked on unpaid leave. A reminder that leave is an accommodation of last resort, not a safe harbor.

which participant communications could move to e-delivery, and the notice-and-access mechanics sponsors would need to build.

the second consecutive year of double-digit projected trend, and the number that will anchor this fall's renewal conversations.

a payroll and policy update for any employer with San Francisco headcount.

CBIZ's monthly compliance calendar: state vaccine-assessment filings due August 15 in New Hampshire and Maine, Washington PAL program payments due September 1, and Connecticut's health and welfare fee assessment due September 30.

A May cyberattack on DentaQuest, the dental and vision benefits administrator serving 32 million Americans, compromised the health data of at least 15 million individuals, the largest health data breach reported to federal regulators this year. Plan sponsors whose group plans use DentaQuest should be reviewing their business associate agreements and notification obligations.

The detailed accounting, published as notification letters began going out: names, Social Security numbers, member and Medicaid/Medicare identifiers, and dental and vision treatment and billing information, with independent analysis suggesting up to 23.4 million unique individuals, including 1.7 million Social Security numbers that appear to belong to children. Affected individuals are being offered 24 months of credit monitoring.

The security press take from late July: the ShinyHunters extortion group claimed responsibility for the May intrusion, stealing 234 GB of data after ransom negotiations failed, with files dating back to 2009 and a final assessment above 23.4 million people, well past the 15 million in initial reports.

Lockton's compliance team digs into the section 129 half of this week's proposed regulations and finds the detail vendors will care about most: the 55% average benefits test denominator counts only employees actually receiving dependent care assistance, not the whole workforce. The alert walks through correction mechanics for failed tests and advises employers to test early and verify their vendor's methodology for 2026.

Warner Norcross joins the e-disclosure commentary with the practitioner's sigh of relief in the title: the DOL's proposed additional safe harbor would let group health plan administrators furnish required disclosures electronically.

Sidley joins the e-disclosure commentary, analyzing the DOL's proposed notice-and-access safe harbor for group health plans and what sponsors should weigh before relying on it.

Preparing for Maryland's FAMLI program will require coordination across HR, payroll, benefits, and legal teams. Ballard Spahr on the requirements and the planning employers should start now.

Bricker Graydon on the health-premium recovery question every employer eventually faces: what happens to premiums the employer advanced during FMLA leave when the employee never comes back.

Recent FTC orders require Caremark Rx and Express Scripts to stop favoring high-list-price drug versions over their standard formularies. IFEBP looks at the settlement terms most relevant to plan sponsors and members.

Groom unpacks Notice 2026-28, the first guidance on the now-permanent section 45S paid-leave credit since the OBBBA amendments, including how to calculate the credit when an employer funds PFML through insurance premiums rather than paying wages directly. The notice led the Digest on August 6; this is the first full firm analysis.

Groom reviews CMS's newly announced updates to federal IDR operations and the dispute portal under this year's final rule, a companion read to the implementation timeline guide the Departments released last week.

CMS staffers intend to use the data they collect to implement new federal rules for pharmacy benefit managers serving self-insured employer health plans, an early signal for plan sponsors watching the PBM regulatory front.

Troutman's take on the DOL's proposed electronic-disclosure rules for group health plans, joining the Spencer Fane and Kilpatrick analyses readers saw Friday: a notice-and-access safe harbor that would make electronic delivery of required notices substantially easier.

Rising use of the weight-loss drugs is fueling the fastest health plan cost growth in a decade and a half, forcing employers to rethink coverage strategies and cost management.

The recent spate of wildfire-induced air pollution provided a view of the direct effect extreme weather events may have on leave management.

Starting January 1, 2027, Illinois employers with at least 26 employees must provide employees with paid leave for jury service.

Segal examines what the early end of the Medicare Part D Demonstration program means for premiums and retiree health plans.

The Departments of Labor, HHS, and the Treasury, together with OPM, released an implementation timeline guide for the federal IDR operations final rules, laying out when certified IDR entities and disputing parties must meet the new requirements.

A Milliman white paper on the GLP-1 market's dramatic growth, with U.S. spending rising from $13.7 billion in 2018 to $71.7 billion in 2023, now the largest and fastest-growing drug category. The authors examine payer coverage policies, utilization management, and cost containment, and urge payers to evaluate total cost of care, adherence durability, and long-term clinical return on investment rather than drug unit costs alone.

Francisco's mayor signed Ordinance 162-26, lowering the length of time an employee must be employed before qualifying for supplemental compensation under the city's Paid Parental Leave Ordinance.

After 24 years, the Department of Labor is looking to leave “snail mail” behind. Proposed electronic disclosure rules would make it easier for ERISA-covered group health plans to deliver required notices electronically while preserving important participant protections.

The Department of Labor has issued a proposed rule to create a new, optional electronic disclosure safe harbor for ERISA group health plans. If finalized, this proposal would allow the provision of required disclosures electronically to a broader group through a notice-and-access framework.

Milliman examines how employers are positioning fertility coverage amid cost pressures and new market dynamics, covering utilization trends, treatment costs, benefit design approaches, and emerging access pathways through retail and digital health partnerships, against a backdrop of state mandates and drug-pricing initiatives.

Quarles & Brady breaks down the DOL's proposed safe harbor letting group health plans deliver required disclosures electronically by default, the latest in the wave of firm commentary on the July 23 proposal.

CMS announced that on November 1, 2026 the federal IDR portal (becoming the IDR Gateway) will change how batched disputes are handled under the No Surprises Act IDR rules, a process note for self-funded plans and the TPAs managing their surprise-billing disputes.

The IRS provides guidance on new requirements for the employer credit for paid family and medical leave under section 45S, reflecting the permanent expansion of the credit under the Working Families Tax Cuts Act.

The HHS Office for Civil Rights announced two separate HIPAA enforcement actions against self-funded group health plans following ransomware breaches, a signal that plan-level HIPAA compliance, not just the employer's, is squarely in OCR's sights.

The U.S. Department of Labor issued a proposed rule that would bring group health plans in line with the electronic disclosure rules already applicable to retirement plans, creating a safe harbor that lets health plans deliver required disclosures electronically by default.

The Consolidated Appropriations Act (CAA) of 2021 expanded service provider fee disclosure requirements already in place for retirement plans to apply to group health plans.

A study by EBRI and Morgan Health found employers are interested in adopting individual coverage health reimbursement accounts, but knowledge gaps and hesitation to implement remain.

Kevin Crain says the future of financial wellness depends on whose interests come first.