Health Plans

Healthcare costs in the United States remain a major concern for patients and policymakers alike. Many Americans face unexpected bills after hospital visits, often without clear information about prices beforehand. Since January 2025, several bills have recently been introduced in Congress aiming to improve transparency in hospital pricing and billing. This article summarizes five key pieces of legislation designed to make healthcare costs clearer and more predictable for pat

Mergers and acquisitions (M&A) often bring big changes to companies, but one area that frequently causes problems is employee benefits. When two organizations combine, aligning benefit plans can be complicated. Mistakes in this process can lead to employee dissatisfaction, legal risks, and increased costs. Understanding the most common pitfalls helps companies protect their workforce and maintain smooth transitions. Mistake 1: Overlooking Benefit Plan Differences Early One of

A May 2026 proposed rule titled Excepted Fertility Benefits introduces a new category of limited excepted benefits under the Affordable Care Act (ACA). This rule aims to establish certain fertility benefits as separate from traditional group health plans, potentially improving the ability of employers to provide group health plan participants with access to, and the ability to better manage fertility-related care. What Are Excepted Benefits under the ACA? The ACA imposes cert

The Affordable Care Act's (ACA) nondiscrimination rule, known as Section 1557, has been one of the most important legal frameworks affecting access to healthcare for transgender individuals. Over the last decade, however, the meaning and enforcement of Section 1557 - especially as it relates to gender identity and gender-affirming care - have shifted repeatedly through rule-making, court decisions, and agency guidance. For employers, health plan sponsors, providers, and patie

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