The Daily Brief for Benefits Professionals
BenefitsWire
Health & Welfare Plans
July 20, 2026
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8 items · ~3 min read
Top of the Brief
Court Stays Challenged Provisions of the 2027 Notice of Benefit and Payment Parameters Final Rule“The Plaintiffs’ challenges were focused on provisions of the 2027 Notice of Benefit and Payment Parameters Final Rule (NBPP final rule) which they argued imposed barriers to coverage, increased costs for enrollees, and permitted issuers to offer less comprehensive coverage. The court granted all of the Plaintiffs’ motions for a stay in Columbus II as follows: Issuers will now have to quickly re-adjust plan options in preparation for the 2027 plan year. We expect CMS to issue guidance on its approach to necessary changes given the stay.”
In this issue
Regulatory Action and Guidance (4) · Litigation (4)
Regulatory Action and Guidance
4 items“The Plaintiffs’ challenges were focused on provisions of the 2027 Notice of Benefit and Payment Parameters Final Rule (NBPP final rule) which they argued imposed barriers to coverage, increased costs for enrollees, and permitted issuers to offer less comprehensive coverage. The court granted all of the Plaintiffs’ motions for a stay in Columbus II as follows: Issuers will now have to quickly re-adjust plan options in preparation for the 2027 plan year. We expect CMS to issue guidance on its approach to necessary changes given the stay.” MORE >>
Source: Groom Law Group
CMS is seeking public comment on draft guidance for the Medicare Drug Price Negotiation Program, detailing how manufacturers will implement maximum fair prices starting in 2028 under the Inflation Reduction Act. This impacts drug pricing strategies for Medicare beneficiaries. MORE >>
Source: Centers for Medicare & Medicaid Services
“Beginning with 2027 plan years, the simplified determination methodology will be retired. Going forward, employers must determine creditable status through actual actuarial equivalence testing or use of the revised simplified determination method. Under the revised simplified determination method, a plan’s prescription drug benefit will be considered creditable if the plan: CMS has also said that the required actuarial value percentage (73% for 2027) will likely see further increases in future years. Because of these changes, some employer-sponsored plans that previously had creditable prescription drug coverage may no longer satisfy the increased standards.” MORE >>
Source: moreton.com
“The abstract for this agenda item notes that the 2024 independent contractor rule has been subject to legal challenges. The DOL is seeking to rescind the 2024 rule and replace it with a modified version of the 2021 independent contractor rule issued during the first Trump administration. Relatedly, the DOL is seeking to update regulations that would make clear the analysis for determining independent contractor status under the FLSA applies to the Family and Medical Leave Act (FMLA) and Migrant and Seasonal Agricultural Worker Protection Act (MSPA).” MORE >>
Source: Ogletree Deakins
Litigation
4 items“In Cyr v. Reliance Standard Life Insurance Company, No. 2:23-cv-06286-DSF-RAO, 2026 WL 2056667 (C.D. Cal. July 15, 2026), United States District Judge Dale S. Fischer, following a bench trial on the administrative record, found in favor of a long-term disability claimant whose ERISA benefits Reliance Standard Life Insurance Company had paid for two decades before terminating them. Reviewing the denial de novo, the court held that Plaintiff had proven by a preponderance of the evidence that she could not perform the material duties of her regular occupation, both because of cognitive impairments and because she could not meet the physical requirements of even a sedentary job.” MORE >>
Source: Roberts Disability Law
“In Scorzo v. Unum Life Insurance Company of America, No. 23-cv-3836, 2026 WL 2070002 (N.D. Ill. July 17, 2026), United States District Judge Jeffrey I. Cummings granted judgment to Unum and denied Plaintiff’s cross-motion, holding that Plaintiff, a former Starbucks store manager with multiple sclerosis, failed to prove by a preponderance of the evidence that she was unable to perform any gainful occupation under the ERISA-governed long-term disability plan. The decision illustrates how the two-tiered “own occupation” to “any occupation” definition of disability operates against a claimant even when the underlying diagnosis is undisputed and review is de novo.” MORE >>
Source: Roberts Disability Law
“The court first addressed standing in light of anti-assignment provisions Cigna identified in at least 36 of the 114 plans. As to 29 plans containing both a general anti-assignment provision and a separate provision authorizing subscribers to direct payment to a provider, the court agreed with Plaintiffs that the specific payment carve-out qualified the general anti-assignment language. Applying the federal common law of contract and the principle that specific provisions control over general ones, the court held that subscribers’ invocation of the carve-out to assign the right to payment carried with it the right to sue for non-payment, so the anti-assignment provisions in those plans did n” MORE >>
Source: Roberts Disability Law
“These three major hospital systems are seeking an estimated $250 million in savings they accuse CVS of improperly diverting, plus damages, declaratory relief, and an injunction against further diversion of savings. Under the 340B program, eligible healthcare providers can buy certain prescription drugs at significantly reduced prices. The theory behind the program is that the providers will use the savings to provide healthcare for uninsured and low-income patients.” MORE >>
Source: Hall Benefits Law