The Daily Brief for Benefits Professionals
BenefitsWire
Health & Welfare Plans
August 4, 2026
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7 items · ~2 min read
In this issue
Regulatory Action and Guidance (1) · Health & Welfare Plans (3) · Litigation (2) · General Benefits (1)
Regulatory Action and Guidance
1 itemThe Centers for Medicare & Medicaid Services finalized updates to Medicare's inpatient prospective payment systems for acute care and long-term care hospitals, affecting FY2027 rates and quality programs. This rule also adopts updated health IT standards. MORE >>
Source: Federal Register
Health & Welfare Plans
3 items“Unexpected expenses have become one of the biggest blind spots in employee benefits, according to Catherine Scagnelli, head of growth at financial wellness company Canary. "The reality is that many employees aren't financially unstable because they don't earn a paycheck," Scagnelli said. "They're financially vulnerable because they don't have enough liquidity to absorb life's inevitable surprises." Nearly six in 10 Americans (59%) don't have enough savings to cover a $1,000 emergency, according to data from Canary.” MORE >>
Source: Employee Benefit News
“Providers win 88% of Independent Dispute Resolution cases under the No Surprises Act. When they do win, analyses of CMS data show median awards averaging roughly 450% of comparable in-network rates. In the first three years of the IDR program, excess costs to the healthcare system exceeded $5 billion. Administrative fees alone hit $844 million in the first half of 2025, nearly matching every dollar spent on IDR administration from 2022 through 2024 combined. For health plan CFOs and CEO’s, those figures represent real, trackable budget exposure, not a market-level abstraction. Every arbitration loss is a payment your payer organization made above a defensible in-network rate, a dollar that i” MORE >>
Source: Healthcare Dive
"A study by EBRI and Morgan Health found employers are interested in adopting individual coverage health reimbursement accounts, but knowledge gaps and hesitation to implement remain." MORE >>
Source: PLANSPONSOR
Litigation
2 items“In O’Connor v. Metropolitan Life Insurance Company, No. 4:24-cv-08723-YGR, 2026 WL 2220173 (N.D. Cal. July 29, 2026), Chief United States District Judge Yvonne Gonzalez Rogers granted Plaintiff’s motion for judgment under Federal Rule of Civil Procedure 52 and denied Defendant’s cross-motion, finding that Plaintiff was disabled under her ERISA-governed long-term disability plan’s “any occupation” standard at the time MetLife terminated her benefits. The court found that cognitive difficulties associated with Plaintiff’s asymmetric hearing loss precluded her from performing an executive-level sales management position, even though her formal neuropsychological testing produced average and abo” MORE >>
Source: Roberts Disability Law
“The California Supreme Court today rejected the theory that Gilead violated a duty of care to users of one HIV drug because it did not immediately commercialize another HIV drug fast enough. “[W]e conclude that drug manufacturers do not owe a duty of care to users of a nondefective drug when making decisions about whether and when to commercialize an allegedly safer alternative drug.” Justice Groban, writing for the Court” MORE >>
Source: Gibson Dunn
General Benefits
1 item“ACA Marketplaces insurers are proposing a median premium increase of 15% in 2027, according to KFF’s updated analysis of 276 insurers with publicly available filings across all 50 states and the District of Columbia. This is the second consecutive year of double-digit premium hikes. Last year’s median nationwide proposed rate change was 18%, and the median finalized rate change was 20%.” MORE >>
Source: KFF