Health Plans

Pharmacy Benefit Managers (PBMs) play a crucial role in managing prescription drug benefits for health plans, employers, and government programs. Yet, their complex business practices have often raised concerns about transparency, pricing, and patient access to medications. The 2026 PBM transparency regulations aim to address these issues by requiring PBMs to disclose more detailed information about their operations, pricing, and rebates. This blog post explains what these ne

When a health benefit claim is denied, it can feel overwhelming and confusing. Many employees don’t know where to turn or what steps to take next. Understanding how to respond to a denied claim under ERISA (Employee Retirement Income Security Act) can protect your rights and help you get the benefits you deserve. This guide walks you through the process of handling denied health benefit claims, including important deadlines, internal appeals, and when legal action might be ne

Administering health plans under ERISA (Employee Retirement Income Security Act) involves complex rules that employers, HR teams, and benefits administrators must follow carefully. Mistakes in compliance can lead to costly penalties, legal disputes, and unhappy employees. This post highlights the most common practical errors in ERISA compliance and offers clear guidance to help you avoid them. Failing to Provide Required Notices on Time One of the most frequent ERISA complian

Employer-sponsored health plans play a crucial role in providing healthcare coverage to millions of workers and their families in the United States. Behind the scenes, a federal law called ERISA shapes how these plans operate, what protections they offer, and what obligations employers must follow. Understanding ERISA is essential for employers, plan administrators, and employees alike to navigate health benefits effectively and ensure compliance. This post explains what ERIS