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News & Updates

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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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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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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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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MMO: COSE Benefit & Balanced Solutions Plans Will No Longer Include MedMutual Pet™–Powered by Wagmo

  • On April 9, 2025
Topic: Benefits | Applies to: COSE Benefit Plan (1-50) and Balanced Solutions (10-50) Effective at the group’s next renewal, COSE Benefit Plan (1-50) & Balanced Solutions (10-50) plans will no longerinclude the pet wellness benefit, MedMutual Pet™ – Powered by Wagmo. This change impacts groups renewingon or after May 1, 2025. Medical Mutual will notify impacted […]
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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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MMO: Midsize 51-99 Product Portfolio Enhanced with New Additions

  • On April 1, 2025
Topic: Marketing | Applies to: Mid-size Group Business (51-99) Medical Mutual is excited to announce enhancements to the 51-99 standard portfolio of benefits available to quote beginning April 1, 2025, for effective dates beginning July 1, 2025. ** R22 refers to the current standard portfolio and R19 refers to the old standard portfolio. Click here to […]
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15 Drastic Cost Containment Policies for Employers in a Fiscal Emergency

  • On March 31, 2025
It is no secret that the Trump Administration has cut government funding grants for a vast array of organizations. Many employers that relied upon these grants to finance their operations are now left reeling amidst an unexpected shortage of capital. Under circumstances such as these, it may be advisable for affected organizations to consider more drastic […]
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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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