The Daily Brief for Benefits Professionals
BenefitsWire
Health & Welfare Plans
July 1, 2026
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9 items · ~4 min read
In this issue
Health & Welfare Plans (4) · Litigation (2) · General Benefits (3)
Health & Welfare Plans
4 items“The new law's notice requirement, going into effect in late 2028 for all size employers regardless of ERISA status, imposes a $10,000 per day penalty for failing to provide the required notice. ... For changes to ERISA plans, fiduciaries have an obligation to review compensation and contracts for reasonableness to avoid engaging in a prohibited transaction. ... this is the largest penalty seen thus far for failing to provide a specific notice.” MORE >>
Source: Nava Benefits
[Regulatory Action and Guidance]
$3.84 PCORI Fee Due July 31 — Step-by-Step Form 720 Filing Guide“IRS Notice 2025-61 adjusts the Patient-Centered Outcomes Research Institute (PCORI) fee to $3.84 per covered individual for health plan years ending on or after October 1, 2025 and before October 1, 2026, including 2025 calendar plan years. This represents a 37-cent increase from last year's $3.47 PCORI fee. Action Item: The annual PCORI fee must be reported and paid to the IRS by July 31, 2026, via the second quarter Form 720 (Rev. June 2026).” MORE >>
Source: newfront.com
[Regulatory Action and Guidance]
DOL and CMS Reveal MHPAEA Enforcement Results: 56 Plans Reviewed, 33 Violations Found“The DOL and HHS released their most recent MHPAEA enforcement report (FY October 2023–September 2024), finding 33 violations across 56 reviewed plans. Common violations included applying 30% coinsurance only to MH/SUD outpatient services, impermissibly higher MH copays versus medical/surgical office visits, blanket precertification for all MH/SUD services without a comparable M/S requirement, and exclusion of ABA therapy. Employers should audit plan designs against these enforcement themes.” MORE >>
Source: Hub International
[Regulatory Action and Guidance]
Stakeholder Alert: CMS Seeks Public Input to Inform PBM Compensation Rulemaking Under the CAA, 2026“Section 6224 of the Consolidated Appropriations Act, 2026 (CAA, 2026), restricts PBMs and their affiliates to receiving only "bona fide service fees" (BFSFs) in connection with covered Part D drugs beginning in 2028. ... PBMs must also file annual data reports covering drug costs, enrollee out-of-pocket spending, direct and indirect remuneration (DIR), pharmacy reimbursement, and retained PBM revenue. CMS must define the key terms that determine how far these requirements reach.” MORE >>
Source: frierlevitt.com
Litigation
2 items“In Williams v. Lawrence Livermore National Security, LLC Benefits and Investment Committee, No. 24-cv-07593-VC, 2026 WL 1865363 (N.D. Cal. June 29, 2026), United States District Judge Vince Chhabria granted in part and denied in part Plaintiff’s motion for summary judgment on his ERISA breach of fiduciary duty claim, and denied the defendants’ cross-motion in full. The court held that the plan fiduciaries breached their ERISA duties by giving Plaintiff materially false benefits advice, but found that a trial is needed to determine what monetary relief Plaintiff can recover.” MORE >>
Source: Roberts Disability Law
“In Flowers v. Caremark PCS Health, LLC, No. 25-3068, — F.4th —-, 2026 WL 1859929 (8th Cir. June 29, 2026), the Eighth Circuit held that ERISA preempts Arkansas's geographic pharmacy network adequacy requirements and affirmed the dismissal of a plan participant's unjust enrichment class action. ... The requirements force PBMs to tailor and continually retailor their networks, and potentially build new pharmacies, as members relocate, areas change classification, or in-network pharmacies close. The court concluded that these requirements interfere with the nationally uniform plan administration that ERISA was enacted to protect, and that ERISA therefore preempts them, rendering them without ef” MORE >>
Source: Roberts Disability Law
General Benefits
3 items“If your company sponsors a health plan, especially a self-funded one, there is a good chance that you, or someone on your team, is an ERISA fiduciary. Most people in that position have never been told so....” MORE >>
Source: JD Supra
“President Donald Trump nominated Acting Secretary of Labor Keith Sonderling to permanently head the Department of Labor via a social media post on Monday. ... Sonderling needs Senate approval to remain in the post permanently, and his nomination will proceed through the Senate Committee on Health, Education, Labor and Pensions. ... If confirmed, Sonderling would continue to lead the DOL's efforts to oversee the country's workforce and advance several administration priorities, including a heavily watched rule often referred to as the alternative investments rule, which provides a legal framework for fiduciaries to consider when selecting any investment for retirement plans they oversee.” MORE >>
Source: PLANADVISER
[Regulatory Action and Guidance]
Virginia enacts paid family and medical leave mandate (with slide deck)“Virginia is the first state since 2023 to enact a law (2026 Chs. 981/1093, SB 2/HB 1207) establishing a mandatory paid family and medical leave (PFML) insurance program. By October 1, 2027 (and annually thereafter), the Virginia Employment Commission (VEC) will set the contribution rate, based on wages and capped at the Social Security taxable wage base (SS Max). Contributions — evenly split between employers and employees, with an exception for certain small employers — will start on April 1, 2028. Benefits will first become available on December 1, 2028.” MORE >>
Source: Mercer
Also of Note
- HHS Releases Effectuated 2026 ACA Marketplace Enrollment Data: Nearly 4 Million Drop Coverage — “The Department of Health and Human Services (HHS) today released the effectuated data for 2026 enrollment in the Affordable Care Act marketplace which show only 19.” (Insurance News Net)