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Navigating PCORI Fees for Self-Insured Health Plans and HRAs

  • On April 28, 2025
The Affordable Care Act (ACA) imposes a fee on issuers of specified health insurance policies and plan sponsors of applicable self-insured health plans to help fund the Patient-Centered Outcomes Research Institute (PCORI). The IRS has provided this helpful chart for more information on whether a type of insurance coverage or arrangement is subject to the fee. Note that […]
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Executive Order Targets Prescription Drug Costs and PBM Transparency

  • On April 21, 2025
On April 15, 2025, President Donald Trump signed an executive order aimed at curbing prescription drug prices in the U.S. The order directs multiple federal agencies to take steps toward increasing transparency and accountability in the pharmaceutical supply chain, focusing on the role of pharmacy benefit managers (PBMs). Among the key directives is an order for the […]
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Supreme Court Decision Shifts Burden in ERISA Fee Dispute Case

  • On April 21, 2025
On April 17, 2025, the U.S. Supreme Court issued a unanimous decision in Cunningham v. Cornell University allowing employees to challenge specific fee arrangements between their employer and retirement plan service providers under the Employee Retirement Income Security Act (ERISA). The Court adopted an employee-friendly interpretation of the law, making it easier for workers to bring claims […]
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CMS Releases Updated Guidance on Creditable Coverage Determination for 2026

  • On April 14, 2025
On April 7, 2025, the Centers for Medicare & Medicaid Services (CMS) finalized instructions regarding changes to the Medicare Part D program that take effect in 2026. These updates, stemming from the Inflation Reduction Act of 2022, affect how employer-sponsored prescription drug plans will be evaluated for “creditable coverage” status. What is Creditable Coverage? Employers offering prescription […]
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Updated CHIP Notice Model Released by U.S. Department of Labor

  • On April 14, 2025
The U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) has issued an updated model Employer CHIP Notice reflecting information as of March 17, 2025. What Employers Need to Know Under the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), employers offering group health coverage must provide an annual notice to employees residing in […]
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Understanding the Summary Plan Description (SPD) Requirements under ERISA

  • On April 7, 2025
When employees become participants in a health benefits plan governed by the federal Employee Retirement Income Security Act (ERISA), they must automatically receive an important document: the Summary Plan Description (SPD). However, many employers find themselves confused about this critical ERISA requirement, which could lead to legal and financial risks. Consequences of Non-Compliance with SPD […]
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Litigation Surrounding Tobacco Use Premium Surcharges

  • On March 24, 2025
A number of class-action lawsuits have been filed against employers, claiming that premium surcharges for tobacco use violate federal regulations. These suits have been brought by current and former employees of large U.S. companies, including PepsiCo, Walmart, Target, and Whole Foods, who argue that their health plan premiums were higher due to their tobacco use, […]
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Can Employers Offer Different Benefits to Different Groups of Employees?

  • On March 17, 2025
The Health Insurance Portability and Accountability Act (HIPAA) prohibits group health plans and group health insurance issuers from discriminating against individuals regarding eligibility, premiums, or coverage based upon a health status-related factor. The HIPAA nondiscrimination provisions set forth eight “health factors” that may not be used to discriminate in health coverage among individuals: Similarly Situated Individuals While […]
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White House Releases New Executive Order on Healthcare Price Transparency

  • On March 10, 2025
The Trump administration has released another executive order (EO) with the potential to impact employers. It is titled “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information.” This EO, intended to increase enforcement of price transparency requirements, orders the Department of Labor, Treasury, and Department of Health and Human Services […]
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