The Daily Brief for Benefits Professionals
BenefitsWire
Health & Welfare Plans
September 1, 2026
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9 items · ~3 min read
Top of the Brief
Employers Are Absorbing the Costs of a Surprise Billing Arbitration System“Six years in, the No Surprises Act (NSA) has delivered on one critical promise: patients are protected from surprise out-of-network medical bills. But new Georgetown University research published in Health Affairs Forefront shows the law’s arbitration system is imposing staggering (and exponentially increasing) costs behind the scenes — more than $22.4 billion in estimated costs over just four years — with employers and workers ultimately absorbing the pressure. The new analysis updates prior cost estimates and demonstrates that the NSA’s independent dispute resolution (IDR) process has not proven to be the cost saver lawmakers expected. Dispute volume, awards, and provider win rates continu”
In this issue
Regulatory Action and Guidance (1) · Health & Welfare Plans (3) · Litigation (1) · General Benefits (4)
Regulatory Action and Guidance
1 item“ACA FAQ Part 74 now provides welcome relief. The Departments acknowledged that the regulations do not clearly require retroactive application of the reward and announced they will not take enforcement action against plans that apply the reward prospectively after an employee satisfies a reasonable alternative standard. In other words, if an employee completes a tobacco cessation program during the plan year, the employer generally may stop applying the surcharge going forward without refunding surcharges previously collected that year. The new guidance does not eliminate all compliance concerns.” MORE >>
Source: Bricker Graydon
Health & Welfare Plans
3 items“Six years in, the No Surprises Act (NSA) has delivered on one critical promise: patients are protected from surprise out-of-network medical bills. But new Georgetown University research published in Health Affairs Forefront shows the law’s arbitration system is imposing staggering (and exponentially increasing) costs behind the scenes — more than $22.4 billion in estimated costs over just four years — with employers and workers ultimately absorbing the pressure. The new analysis updates prior cost estimates and demonstrates that the NSA’s independent dispute resolution (IDR) process has not proven to be the cost saver lawmakers expected. Dispute volume, awards, and provider win rates continu” MORE >>
Source: ERIC
“The conditions employees are carrying into work have grown more complex, more financially entangled and harder to treat through the episodic, siloed benefit structures most employers rely on. AI-driven job insecurity is reshaping the psychological contract between workers and employers. Emerging risks like sports betting and the behavioral side effects associated with GLP-1s are creating mental health ripple effects most benefit structures aren't equipped to catch or address.” MORE >>
Source: Employee Benefit News
[General Benefits]
HIPAA for Self-Funded Plans and TPAs: The covered entity distinction“In our earlier post, we covered the basics. A self-funded group health plan is generally a covered entity within the meaning of the Health Insurance Portability and Accountability Act, while the third-party administrator that processes claims is a business associate....” MORE >>
Source: Constangy, Brooks, Smith & Prophete, LLP
Litigation
1 item“A partnership between rival drug middlemen Prime Therapeutics and Express Scripts depressed reimbursement rates for pharmacies in Florida, according to a new lawsuit.” MORE >>
Source: Healthcare Dive
General Benefits
4 items“The 2027 ACA Marketplace proposed earlier this year went into effect in July, according to the Centers for Medicare and Medicaid Services. However, several of its key provisions have been blocked by a federal court and are currently still on hold, further complicating the proposal's progress and potentially stunting leaders' understanding of what it means for them. And while the proposal's overall impact is still unclear, there are many things for leaders to know. "The goal is [supposed to be] to make sure financial assistance is going to people who actually meet the requirements for it," said Jennifer Schaefer, founder and CEO of benefit platform JS Benefits Group. "But this is still a work” MORE >>
Source: Employee Benefit News
“In the backdrop, inflation is expected to cool next year while healthcare costs rise.” MORE >>
Source: PLANSPONSOR
[Regulatory Action and Guidance]
Walberg, Mackenzie Seek Audit of Additional DOL Agencies Following Inspector General FindingsHouse Republicans asked the DOL's Inspector General to audit additional agencies for improper information sharing with trial lawyers and advocacy groups, following a prior audit that found deficiencies in controls and oversight. MORE >>
Source: House Education & Workforce Committee
“As healthcare costs continue to dominate conversations in the C-suite, helping employees understand where their premium dollars can be best utilized is a no-cost way to save both sides money.” MORE >>
Source: Employee Benefits News
Also of Note
- The expanding role of AI in open enrollment, part 1 — “As artificial intelligence deepens its imprint into daily lives, this game-changing technology holds great promise for streamlining the upcoming open-enrollment season, erasing confusion, personalizing content, and securing better outcomes.” (Employee Benefit News)