The Daily Brief for Benefits Professionals
BenefitsWire
Health & Welfare Plans
August 14, 2026
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9 items · ~3 min read
Top of the Brief
5th Circuit strikes down No Surprises billing benchmark in win for providers“The appeals court ruled Tuesday that insurers can’t include ghost rates or exclude bonus payments in calculating a key metric used to determine provider reimbursement for out-of-network bills.”
In this issue
Regulatory Action and Guidance (3) · Health & Welfare Plans (2) · Litigation (2) · General Benefits (2)
Regulatory Action and Guidance
3 items“On August 11, 2026, the Centers for Medicare & Medicaid Services (CMS) finalized a rule restricting the use of federal Medicaid and Children’s Health Insurance Program (CHIP) funds for certain gender-affirming medical interventions provided to minors. ... While this rule is targeted at federal Medicaid and CHIP funding rather than employer-sponsored group health plans, it may have implications for employers and other stakeholders that coordinate coverage across public and private programs.” MORE >>
Source: Groom Law Group
“This rule finalizes new requirements relating to the disclosure of information that group health plans and health insurance issuers offering group or individual health insurance coverage must include along with the initial payment or notice of payment denial for items and services subject to the surprise billing protections. The final rule became effective this month and includes several key provisions: Payers subject to the Federal IDR process must register with the Federal IDR Registry within 90 business days after the date the registry becomes available or the date the payer begins offering coverage subject to the Federal IDR process. Plans must communicate information by using claim adju” MORE >>
Source: pyapc.com
“The new safe harbor would allow plans to provide many required disclosures electronically by posting them on a secure website or portal if they send participants an electronic Notice of Internet Availability (NOIA) of the required disclosures. ... This proposed rule would create an additional optional safe harbor allowing group health plans to provide required documents electronically through an NOIA model, while preserving individuals’ rights to request free paper copies or opt out of electronic delivery.” MORE >>
Source: Segal
Health & Welfare Plans
2 items“Most employers know that health coverage generally must continue during Family and Medical Leave Act (FMLA) leave. The more difficult questions tend to arise later when premiums were never collected, or an employee fails to return from leave. Here are a few FMLA rules employers should keep in mind.” MORE >>
Source: Bricker Graydon
[Regulatory Action and Guidance]
Florida Launches Antitrust Investigation into CVS Health and PBM Caremark“Florida’s Attorney General has announced an antitrust investigation into CVS Health and Caremark, CVS’s wholly owned pharmacy benefit manager (PBM). Similar investigations are occurring in multiple states over PBMs’ business practices, including issues related to transparency, reimbursement, and market concentration. Arkansas and Tennessee have even enacted state laws to limit pharmacy ownership of PBMs, although those laws face legal challenges.” MORE >>
Source: Hall Benefits Law
Litigation
2 items“Because Plaintiff conceded she had received benefit payments since 2011, the court reasoned her proof was filed by 2011 at the latest, giving her until 2015 to sue. She filed more than a decade later. Plaintiff argued that the plan’s language excusing delayed proof if given “as soon as reasonably possible” created a factual question about accrual, but the court rejected this because her receipt of benefits necessarily meant proof had already been filed.” MORE >>
Source: Roberts Disability Law
“The appeals court ruled Tuesday that insurers can’t include ghost rates or exclude bonus payments in calculating a key metric used to determine provider reimbursement for out-of-network bills.” MORE >>
Source: Healthcare Dive
General Benefits
2 items“From an organizational perspective, AI can significantly reduce administrative workload by automating routine inquiries and allowing HR professionals to focus on more strategic, people-centered work," said Heather Newton, director of talent and training at domestic violence services provider Child & Family Center. "However, AI should be viewed as a tool that enhances — not replaces — the human element," she added. "With hybrid remote workplaces and AI, human connection has been a growing topic and need for employees.” MORE >>
Source: Employee Benefit News
[Health & Welfare Plans]
Disability claims up 79% as neurodiversity awareness growsDisability discrimination claims have risen by 79% as mental health issues and neurodiversity awareness continue to grow, according to analysis by a law firm. MORE >>
Source: Personnel Today
Also of Note
- Most employers say rising healthcare costs force salary tradeoffs — “Employers cited high drug prices, high-cost claims and hospital prices as their biggest threats to affordability.” (HR Dive)
- Prior Authorization Metrics Provide New Insights into Insurer Practices, but Gaps Remain — “The use of prior authorization by health insurers has come under increased scrutiny in recent years, as nearly 7 in 10 insured adults say prior authorization is a burden when it comes to getting health care.” (KFF)
- Brookings researchers slam assumptions in work requirements rule — “The Trump administration’s analysis of the rule’s impact on beneficiaries and taxpayers isn’t based on actual data, according to the report.” (HR Dive)
- Optional Medicaid and CHIP Coverage for Lawfully Present Immigrant Children Could Mitigate Coverage Losses Due to 2025 Reconciliation Law — “Actions taken by the Trump administration and Congress will likely have major impacts on health and health care for immigrant families, including reducing the number of lawfully present immigrants eligible for federally funded health coverage under the 2025 reconciliation law.” (KFF)
- Health advocacy group sues AMA to make billing codes public — “PatientRightsAdvocate.org is challenging the influential doctor’s association copyright of the current procedural terminology, or CPT, system.” (Healthcare Dive)
- Removal of a Reporting Requirement for Trusts Whose Charitable Contribution Deductions are Solely for Contributions Made by Passthrough Entities — “Proposed Rule on public inspection, scheduled to publish 2026-08-17.” (Federal Register)