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Industry News
Proposed Rule for Electronic Disclosure for Health Plans
On July 23, 2026, the Department of Labor (“DOL”) published proposed regulations that would significantly expand electronic disclosure options for ERISA-covered group health plans. They created a new electronic disclosure safe harbor. The proposal is not yet final; comments are due September 21, 2026. If finalized and published in 2026, the rules would be effective January 1, 2027. As proposed, it would apply on the first day of the first calendar year following publication o
Proposed Rules on Excepted Limited Fertility Benefits
On May 10, 2026, the Departments (of Health and Human Services, Labor, and Treasury) released proposed rules to allow plan sponsors to provide fertility benefits as an excepted limited benefit separate from their major medical plan. If these rules are finalized, fertility services through this limited benefit would not be required to meet other federal group health plan requirements (such as HIPAA, the No Surprises Act, the Affordable Care Act, and others).
Final Regulations on the Independent Dispute Resolution Operations
The Departments of Health and Human Services, Labor, and Treasury (the Departments) and the Office of Personnel Management recently released final rules for group health plans and insurers (the payers); providers, facilities, and providers of air ambulance services (the providers); and certified Independent Dispute Resolution (IDR) entities under the No Surprises Act.
CAA 2026 - Price Transparency
On February 3, 2026, Congress passed, and the President signed the Consolidated Appropriations Act, 2026 (CAA 26), which requires compensation transparency from not only Pharmacy Benefit Managers (PBMs) but from all service providers to group health plans, including third-party administrators (TPAs). These service providers must disclose all direct and indirect compensation they receive in connection with the plan — and it appears that this requirement is effective immediatel
New Model Notice of Privacy Practices
On February 13, 2026, the Department of Health and Human Services (HHS) released a new model Notice of Privacy Practices (NPP) that incorporates new requirements for protecting substance use disorder (SUD) records. The new model notice is available for download from HHS’ website. Covered entities, including health plans that may receive SUD treatment information, were required to update NPPs by February 16 to comply with the requirement.
2026 Proposed Rule - PBM Fee Disclosure
The Department of Labor (DOL) proposed regulations which would require mandatory fee disclosure by Pharmacy Benefit Managers (PBMs) and their affiliated brokers/consultants to fiduciaries of self-insured ERISA group health plans.
A summary of the proposed rule and potential changes can be viewed at the link below.
Final 2026 Creditable Coverage Changes
The Centers for Medicare & Medicaid Services (CMS) issued final guidance on April 7, 2025 with an implementation date of January 1, 2026 on the creditable coverage determination method.
Departments Issue Final Regulations on Mental Health Parity
The Mental Health Parity and Addition Equity Act (MHPAEA) rules released on September 9, 2024, by the Departments of Health and Human...
Gag Clause Prohibition Compliance Attestations
The Consolidated Appropriations Act of 2021 (CAA) prohibits gag clauses in healthcare contracts and requires group health plans and...
PBGC Issues Proposed Rule on Actuarial Assumptions for Withdrawal Liability
The proposed rule makes clear that the use of any interest rate between PBGC rates and funding rates (including a “blended rate”) is a valid
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