Health & Welfare
Worth the Wait: After 45 Years, Dependent Care Assistance Programs Finally Get RegulationsForty-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.
Employers Gear Up for Biggest Healthcare Cost Spike in 20 YearsMarsh'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.
What 30 Years in HR Taught Me About Healthcare Costs and Employee TrustAn 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.
Tri-Agency Guidance Addresses Requirements for Tobacco Surcharge ProgramsMayer 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.
Finance Is 'Leaning In' to Manage Healthcare Costs, WTW Exec SaysWith 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.
Wellness Program FAQs: Agencies Offer Relief on Retroactive Rewards and Clarify Notice RequirementsSeyfarth 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.
New FAQs Offer Relief for Employers Sponsoring Wellness ProgramsBradley'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.
Quitting Cold Turkey: Federal Agencies Suspend Enforcement of Back-Pay Requirement for Employee Wellness Incentives, Including Tobacco Cessation ProgramsSquire 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.
Tobacco Surcharges: New Federal Guidance Gives Employers Some Relief, but Not a Free PassBricker 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 Says No Surprises Is Lowering Spending on Emergency Care. Researchers Aren't Convinced.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.
Employer Health Costs Expected to See Sharpest Increase in 20 Years: SurveyNew 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.
DOL Proposes New Electronic Delivery Safe Harbor for Group Health Plan DisclosuresA 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.
Wellness Program FAQs: Agencies Ease Enforcement While Courts Continue Shaping the RulesLockton 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.
ACA Dollar Amounts and PercentagesSegal'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.
How Personalized Healthcare Guidance Can Stretch Premium DollarsMetLife'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 Cuts Prior Authorization From 1,700 CodesUnitedHealthcare 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.
The Absence Conversation Advisers Can't Afford to OutsourceAn 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.
Navigating the Current Landscape of GLP-1 CoverageAttorneys from McDermott Will & Schulte review the costs, benefits and risks for employers to evaluate when deciding how their benefits address these popular medications.
DOL Proposes E-Delivery for Group Health Plan DisclosuresIn 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.
Plan Sponsors Face Challenges to Providing Mental Health ParityDifferences between physical and mental health services mean ensuring equal care 'in spaces that can be quite different.'
New FAQs Offer Relief for Employers Sponsoring Wellness ProgramsThe 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.
Employers Explore Novel Approaches to Manage Rising Healthcare CostsLeveraging 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.
Tobacco Surcharges: New Federal Guidance Gives Employers Some Relief, But Not a Free PassThe 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.
Employers Are Absorbing the Costs of a Surprise Billing Arbitration SystemERIC'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.
Florida Attorney General Sues PBMs Express Scripts, Prime Over Alleged Price FixingA 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.
HIPAA for Self-Funded Plans and TPAs: The Covered Entity DistinctionA 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.
What the 2027 ACA Marketplace Proposal Means for EmployersWhile the legislation's future is still unclear, there are many important things for leaders to know.
Employers Plan to Continue With Moderate Pay Increases in 2027, per MarshEmployers 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.
The Mental Health Agenda Has Changed, Most Benefits Systems Haven'tToday's complex stressors require clearer access pathways and a company-wide commitment to mental health support.
Maryland FAMLI's Labor Pains: What Unionized Employers Need to KnowThe 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.
DOL Proposes E-Delivery as Default Option for EmployersThe 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.
Fast Facts About the DOL Proposed Rule for Electronic Disclosures for ERISA Group Health PlansThe July 23 proposed rule would give group health plan administrators an additional safe harbor for electronically furnishing required disclosures to participants and beneficiaries.
Texas HB 198 and HB 4144: What Municipalities Need to Know About First Responder Health BenefitsHow Texas HB 198 and HB 4144 affect municipalities, first responder health benefits, cancer screenings, and retiree illness protection.
Childcare Is a Growing Workplace Problem. Here's What Employers Can DoChildcare issues are putting pressure on working parents and employers alike. What benefit leaders should know about costs, tax credits and care.
With Healthcare Costs Jumping 9%, Employers Are Shifting StrategyEmployers face another steep rise in healthcare expenses in 2027, prompting a closer look at GLP-1 coverage, pharmacy spending and high-cost conditions.
Specialty Providers Refute Hefty Georgetown Estimates of No Surprises CostsResearchers 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.
Clearing the Air: Tri-Agencies Issue Enforcement Relief on the Wellness Program “Full Reward” RequirementGroom 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.
Federal Agencies Weigh in on Tobacco Surcharge EnforcementNew 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.
DOL, Other Agencies Address Questions About Wellness Program SurchargesHR 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.
New Electronic Disclosure Rule for Group Health Plan Notices Proposed by DOLOn 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 at an ‘Inflection Point’ as Health Costs Near Double-Digit IncreasesEmployers 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.
“Double Dip” Health Plans Marketed to Employers: Too Good to Be TrueThompson 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.
NJDOL Expands Leave Protections: New Guidance Links TDI and FLI Benefits to Job ProtectionThe 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 Dependent Care FSA Nondiscrimination Rules Are Easier to PassNew 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 Face ‘Existential Reckoning’ as Health Costs SurgeEmployers 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.
HSA Participation Rises, but Savings Potential Remains Largely UntappedPSCA'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.
No Surprises Dispute Resolution Has Generated $22B in Extra Costs, Research FindsAccelerating 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.
Missouri Enacts Law Expanding Job Protections for National Guard MembersIn Missouri, a new military leave law will take effect on August 28, 2026, impacting both public and private employers.
The Expanding Patchwork of State Paid Family and Medical Leave Laws: What Employers Should KnowThe 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.
White House Issues Executive Order on Childhood Vaccine RecommendationsOn 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.
Employer Healthcare Costs to Surge in 2027 Due to Catastrophic Claims, Specialty DrugsRecent projections for 2027 increases range from 9.2% to 11% without plan-design changes.
HSA Participation Hits Record Level Among American EmployeesPSCA survey finds more than 80% of employees contribute to their workplace Health Savings Accounts, but not enough workers are tapping their unique tax advantages.
New Maternity Billing Codes: What Self-Funded Plans Should WatchFor 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.
Healthcare Costs Could Rise by Nearly 10% in 2027Employers cover more than 80% of the burden, but employees will also be hit by rising costs, an Aon report found.
DOL Proposes New Electronic Disclosure Safe Harbor for Group Health PlansOn 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.
No Surprises Act Enters a New Phase: What Employers and Group Health Plans Need to Know About the 2026 IDR RulesThe 2026 regulations standardize claim communications, restructure open negotiation, clarify batching rules, and impose tighter deadlines for determining IDR eligibility. Self-funded plans must register.
Unexpected GLP-1 Side Effect? Studies Show the Meds May Help People With AddictionsFrom 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.
No More Six-Month Baby Steps: San Francisco Cuts PPLO Eligibility Period in HalfThe 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 Seeks Comment on the Categories Used in Federal Vaccine Recommendations and on Shared Clinical Decision-MakingHHS 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.
How AI Is Changing the Mental Health SpaceNearly 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.
Employer Health Costs Projected to Rise 9.5 PercentA 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.
Modernizing Compliance: DOL Proposes Safe Harbor for Electronic Group Health Plan Disclosures Under ERISAAnother 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.
Healthcare Costs Are Rising. Here's How Brokers Can Help Employers RespondGap coverage, supplemental benefits and options for various types of workers can help avoid cost shifting and still provide support.
2026 Healthcare Cost Trends: Medical and Pharmacy Costs Remain HighMedical and pharmacy trends remain high at 7.7% overall. Learn what's driving healthcare costs and what employers should expect moving forward.
Employers Face a New GLP-1 Question: Are the Drugs Worth It?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.
What Employers Need to Know About the Executive Order on Childhood VaccinesA 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.
After 45 Years, the IRS Speaks on DCAP Nondiscrimination Testing – And It’s Good NewsEmployers 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.
Why PBM Audits Matter: 3 Ways That Auditing a Pharmacy Benefit Manager Can Help Employer-sponsored Health Plans Manage Prescription Drug CostsWe 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.
Vorys Benefits Brief: Discrimination Testing for Dependent Care Assistance ProgramsDependent Care Assistance Programs are subject to the nondiscrimination rules that are set forth in Internal Revenue Code Section 129 (Section 129).
Dependent Care FSA Nondiscrimination Testing Gets Easier Under IRS ProposalMercer 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.
Guidance Issued on Nondiscrimination Testing for DCAPsAon'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.
Average HSA Balance Hits Record $5,532, but Most Assets Remain in CashThe 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.
HSA Participants Prioritize Short-Term SpendingPLANSPONSOR's angle on the same EBRI study: HSAs are being used as spending accounts, with only 18 percent of participants investing beyond cash.
Going Digital: DOL Proposes New, Additional E-Delivery Safe Harbor for Group Health PlansGroom 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 Reach Record High, but Contributions and Investing Remain Limited, New EBRI Research FindsAverage 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.
An Employer's Guide to Filing a Declaration of Intent for a Maryland FAMLI Private PlanOgletree'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.
New Maryland DOL Resources Help Employers Prepare for FAMLIThe companion piece: Maryland DOL released new employer resources ahead of the FAMLI program's first deadlines, and Ogletree rounds up what is there.
Illinois Introduces Workplace Protections for Menopause-Related ConditionsIllinois 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.
Illinois' Menopause Equity and Care Act Expands Employment ProtectionsJackson 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.
Why It's Time to Step Up Menopause SupportThe 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.
Healthcare Costs Are Forcing Employers to Reconsider Their Benefits StrategyUnder 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.
Roundup of Selected State Health Developments, Second-Quarter 2026Mercer'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.
What to Know About GLP-1 Demand, Expense and AlternativesA 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.
Most Employers Say Rising Healthcare Costs Force Salary TradeoffsEmployers 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.
Look Before You Leave: 4th Circuit Encourages Other ADA AccommodationsThe 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.
Expanded Electronic Delivery Proposed for Group Health Planswhich participant communications could move to e-delivery, and the notice-and-access mechanics sponsors would need to build.
Employers Project Another 10% Rise in Health Care Costs for 2027the second consecutive year of double-digit projected trend, and the number that will anchor this fall's renewal conversations.
San Francisco's Paid Parental Leave Ordinance Eligibility Shorteneda payroll and policy update for any employer with San Francisco headcount.
August Regulatory & Compliance UpdatesCBIZ'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.
DentaQuest Breach Exposes Data of 15M People, a Record This YearA 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.
DentaQuest Starts Notifying 15 Million+ Individuals About May 2026 Cyber IncidentThe 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.
DentaQuest Disclosed a Data Breach That Impacted 23 Million IndividualsThe 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.
IRS Proposes Rules on Dependent Care FSA Discrimination Testing, Including 55% Benefits TestLockton'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.
Finally! DOL Proposes New ERISA Health Plan Electronic Disclosure RuleWarner 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.
Signed, Sealed, e-Delivered: The DOL Proposes “Notice-and-Access” Electronic Disclosure Safe Harbor for Group Health PlansSidley 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.
Paid Family and Medical Leave Is Coming to Maryland: What Employers Need to KnowPreparing 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.
The FMLA Premium Trap: What Happens When an Employee Never Returns?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.
PBM Settlement Orders Part 2: What Plan Sponsors Should Watch NextRecent 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.
Blended Premiums, Flexible Rules: First Post-OBBB Guidance on the 45S CreditGroom 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.
CMS Announces Updates Regarding IDR Operations and PortalGroom 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 Prepares for New Federal PBM Rules for Self-Insured Employer Health PlansCMS 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.
DOL Proposed Regulations Would Extend Notice-and-Access Electronic Delivery Safe Harbor to Group Health PlansTroutman'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.
GLP-1s Push Health Plan Costs to 15-year HighRising 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.
Could Climate Change Lead to Increased FMLA Use? Attorneys Are Afraid SoThe recent spate of wildfire-induced air pollution provided a view of the direct effect extreme weather events may have on leave management.
Illinois Employers Face New Paid Leave for Jury Service + Stronger Protections for Volunteer Emergency WorkersStarting January 1, 2027, Illinois employers with at least 26 employees must provide employees with paid leave for jury service.
Medicare Part D Demonstration Program Will End on 12/31/26Segal examines what the early end of the Medicare Part D Demonstration program means for premiums and retiree health plans.
Federal Independent Dispute Resolution (IDR) Operations Final Rules Implementation Timeline GuideThe 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.
GLP-1 Medications in the United States: The Status of Coverage, Utilization Management, and Cost in a Rapidly Evolving MarketA 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.
San Francisco Lowers Tenure Requirement for Supplemental Compensation Under Paid Parental Leave OrdinanceFrancisco'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.
Leaving Snail Mail Behind: The DOL’s Proposed Electronic Disclosure Rules for Health PlansAfter 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.
DOL Proposes New Electronic Disclosure Safe Harbor for Group Health PlansThe 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.
Fertility Benefits: Market Landscape and Employer ConsiderationsMilliman 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.
Department of Labor Proposes Electronic Delivery Safe Harbor for Group Health Plan DisclosuresQuarles & 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.
Coming Soon: Changes to Batching Disputes in the Federal IDR ProcessCMS 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.
Notice 2026-28: Guidance on the Employer Credit for Paid Family and Medical Leave Under Section 45SThe 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.
OCR Announces Notable HIPAA Enforcement Actions Against Self-Funded Group Health Plans Following Ransomware BreachesThe 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.
DOL Proposes Rule to Modernize ERISA Health Plan Disclosure DeliveryThe 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.
Sunlight Will Soon Shine on Group Health Plan FeesThe Consolidated Appropriations Act (CAA) of 2021 expanded service provider fee disclosure requirements already in place for retirement plans to apply to group health plans.
ICHRA Interest Is Not a Predictor of AdoptionA 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.
Client-Centric or Firm-Centric?Kevin Crain says the future of financial wellness depends on whose interests come first.
DOL Proposes Default Electronic Delivery Safe Harbor for ERISA Group Health Plan DisclosuresOn July 23, 2026, the U.S. Department of Labor’s Employee Benefits Security Administration (“EBSA”) published a proposed rule (the “Proposed Rule”) that would create a new, additional safe harbor for group health plan administrators to furnish participant and beneficiary disclosures electronically by default.
Technical Guidance: HHS-Administered Federal External Review Process Deadline ExtensionCMS reopened the HHS-administered federal external review process effective July 31 after a month of unavailability. Consumers whose deadline to request external review fell between July 1 and August 3 now have until October 2, 2026 to file. Relevant to plans that elected the HHS process (AL, FL, GA, WI, TX and territories) and self-insured non-federal governmental plans with live claim appeals.
DOL Seeks to Bring Group Health Plan Communications Into the Digital AgeThe U.S. Department of Labor (“DOL”) has proposed a new safe harbor option for group health plans to provide required disclosures electronically. Currently, many health plan notices are still delivered through paper mailings, which can be costly and administratively burdensome.
Proposed Rules Permit New Ways to Electronically Distribute Group Health Plan DocumentsThe DOL recently issued proposed regulations under ERISA that create additional safe harbors for distributing group health plan documents electronically.
DOL Proposal Would Let Health Plans Deliver Documents Electronically by DefaultEmployers would have a clearer path to delivering summary plan descriptions (SPDs) and other required health plan documents electronically to participants who have provided—or been assigned—an electronic address under a proposed “notice and access” regulation from the U.S. Department of Labor’s (DOL) Employee Benefits
Healthcare Employers Can Leverage More Intentional Benefit Design, DeliveryOffering a diverse array of financial wellness solutions can help reach a ‘distributed workforce,’ a recent Commonwealth report suggests.
Measuring Financial Wellness Through Americans’ Rising Debt BurdenConsumer credit trends and household financial health help illustrate the backdrop against which companies are thinking about employee financial wellness.
Constructing Clear, Action-Oriented Communications During Open EnrollmentExperts says plan sponsors should be transparent and should address healthcare costs head-on.
New York Employers Face New Restrictions on Severance, Tuition Repayment, and Sick TimeWhat employers should know about key developments this week: • Severance Agreement Overhaul: The No Severance Ultimatums Act, awaiting Governor Kathy Hochul’s signature, would remove the current age-based restriction, extend a 21-day review period plus a seven-day revocation period to all employees.
DOL Proposes New Electronic Disclosure Safe Harbor for Group Health Plans Under ERISAOn July 23, 2026, the U.S. Department of Labor (DOL) issued proposed regulations that would establish a new safe harbor allowing group health plan administrators to use electronic media to furnish documents and information to participants and beneficiaries under ERISA.
Too Good to Be True? Risks of Indemnity and Wellness Program SchemesThis column explores IRS guidance on these arrangements and potential risks to employers under federal law.
New Jersey Telemedicine and Telehealth UpdateThe New Jersey Legislature recently adopted two bills that extend and expand telehealth flexibilities regarding payors and controlled dangerous substances.
Do You Provide a COBRA Notice for Your On-Site Clinic?Employers who offer an on-site health clinic as an employee benefit may not realize it can qualify as an ERISA group health plan in its own right, which can trigger COBRA notice obligations most sponsors don't associate with an in-house clinic.
IDR Operations Update: A New Gateway and Guidance on Codes | SegalGet compliance insights on the new IDR Gateway, RARC code requirements and next steps for group health plan sponsors.
The Menopause Market Is Becoming Mainstream: What Employers, Providers, and Investors Need to Know NowWith the market projected to reach tens of billions of dollars by 2030 and a growing wave of state coverage mandates prompting employers to add menopause benefits, the opportunities are expanding fast, and so is the regulatory scrutiny.
ICHRA Adoption Slowed by ACA Exchange Costs, Instabilityare making them hesitant to move forward, according to a survey.
First-Ever HIPAA Enforcement Against Self-Funded Health Plans: What Employers Need to KnowOn April 23, 2026, the U.S. Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) announced settlements with four health entities following investigations into ransomware breaches that exposed unsecured electronic protected health information (“ePHI”).
What If? Preparing Your Health Plan for the UnexpectedFrom compliance notices and fiduciary responsibilities to unexpected operational challenges, asking “what if?” helps plan sponsors anticipate risks before they become costly problems.
What the Latest Federal IDR Process Data Means for Self-Insured Group Health PlansThe Departments of Health and Human Services, Labor, and the Treasury (Departments) recently released the Federal Independent Dispute Resolution (IDR) public use files (PUF) and supplemental tables for the third and fourth quarters of 2025.
Virginia Employers: Get Ready for Expanded Paid Sick LeaveVirginia Governor Abigail Spanberger recently signed into law paid sick leave (PSL) entitlements for nearly all employees working in the Commonwealth. The law will have a staggered effective date, with the earliest changes taking effect in mid-2027.
New York Employers Face New Restrictions on Severance, Tuition Repayment, and Sick TimeWhat employers should know about key developments this week: Severance Agreement Overhaul: The No Severance Ultimatums Act, awaiting Governor Kathy Hochul’s signature.
State and Local Governments Battle Over Who’s the Boss of Legislating the WorkplaceLocal governments often lead on workplace issues like paid sick leave, discrimination, and pay equity.
What If? Preparing Your Health Plan for the UnexpectedFrom compliance notices and fiduciary responsibilities to unexpected operational challenges, asking “what if?” helps plan sponsors anticipate risks before they become costly problems.
What the Latest Federal IDR Process Data Means for Self-Insured Group Health PlansThe Departments of Health and Human Services, Labor, and the Treasury (Departments) recently released the Federal Independent Dispute Resolution (IDR) public use files (PUF) and supplemental tables for the third and fourth quarters of 2025.
Virginia Employers: Get Ready for Expanded Paid Sick LeaveVirginia Governor Abigail Spanberger recently signed into law paid sick leave (PSL) entitlements for nearly all employees working in the Commonwealth. The law will have a staggered effective date, with the earliest changes taking effect in mid-2027.
State and Local Governments Battle Over Who’s the Boss of Legislating the WorkplaceLocal governments often lead on workplace issues like paid sick leave, discrimination, and pay equity.
The Fiduciary Tsunami About to Hit Healthcare PlansWhy retirement plan advisors should care.
NYC Updates Earned Safe and Sick Time RulesAfter public comments and hearing, the New York City Department of Consumer and Worker Protection has adopted amendments to the rules implementing the Earned Safe and Sick Time Act (ESSTA), which was established by Chapter 8 of Title 20 of the New York City Administrative Code.
SMBs Have More Options Than Ever and Worse AdviceWhen a level-funded stop-loss corridor, ICHRA contribution strategy and captive loss fund can be assessed against claims data, brokers become interpreters.
Group Health Plan PCORI Fees Due by July 31As a reminder, the deadline for submitting Patient-Centered Outcomes Research Institute (PCORI) fees is July 31. Employers that sponsor self-insured group health plans should use the most current revision of IRS Form 720, Quarterly Federal Excise Tax Return, to report and pay the fees.
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