The Daily Brief for Benefits Professionals
BenefitsWire
Health & Welfare Plans
September 8, 2026
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12 items · ~5 min read
Top of the Brief
Federal Reserve Disability Plan Falls Outside ERISA, But Court Applies ERISA-Style Review to Reverse Denial of Long-Term Disability Benefits“As a threshold matter, the court had previously held, in a December 2025 ruling, that ERISA does not govern this Plan, because it is a Federal Reserve System benefit plan that falls outside ERISA’s coverage. Even so, the decision is instructive for ERISA disability claimants, because the court applied the same arbitrary-and-capricious standard and the same treating-physician and cherry-picking principles that federal courts apply in ERISA cases, relying on Black & Decker Disability Plan v. Nord, 538 U.S. 822 (2003), and on Second Circuit ERISA authority. Plaintiff, a former Federal Reserve Bank of New York employee, sought reinstatement of benefits after Matrix terminated them under the Plan”
In this issue
Regulatory Action and Guidance (5) · Health & Welfare Plans (1) · Litigation (2) · General Benefits (3) · Webinars (1)
Regulatory Action and Guidance
5 items“The Departments explained that they will not take enforcement action against plans or issuers that fail to provide the reward retroactively to the beginning of the plan year for an individual who satisfies the reasonable alternative standard midyear, so long as the reward is provided prospectively. The Departments will exercise this enforcement discretion so long as the plan or issuer, as applicable:” MORE >>
Source: calfee.com
“Published August 27, 2026 The Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the Departments) released Affordable Care Act (ACA) and Health Insurance Portability and Accountability Act (HIPAA) Implementation Frequently Asked Questions (FAQs) Part 74 addressing health-contingent wellness programs, including tobacco-related wellness programs.” MORE >>
Source: ifebp.org
“The Centers for Medicare and Medicaid Services updated the Part D risk adjustment model coefficients to reflect the redesigned benefit, but the structure of the model was unchanged. The model continues to predict drug costs from medical diagnoses without using individual beneficiaries’ prescription drug history, as has always been the case, and its coefficients are calibrated on claims experience from several years before the payment year. That lag has created challenges in the first few years of the redesign, because the change in beneficiary behavior following the redesign is far larger than the year-over-year variation the model normally absorbs.” MORE >>
Source: Milliman
“On August 11, 2026, the Internal Revenue Service issued proposed regulations addressing nondiscrimination rules for dependent care assistance programs (“DCAPs”) under Section 129 of the Internal Revenue Code (the “IRC”). More than 45 years after DCAPs were enacted under IRC § 129, these proposed regulations provide long-awaited guidance on DCAP nondiscrimination testing and also address employer contributions and nondiscrimination rules for Trump Accounts. For additional information on Trump Accounts, see our blogs here and here. A DCAP allows employees to pay eligible dependent-care expenses with pre-tax dollars. Employers may also contribute to an employee’s DCAP. For 2026, the maximum amo” MORE >>
Source: Seyfarth (Beneficially Yours)
“Plan sponsors can disregard the rule’s consumer notice requirements, which have been invalidated by a federal court. But the IRS hasn’t changed its position with respect to fixed-indemnity, wellness “double-dipping” schemes — that is, programs that impermissibly combine pretax premiums with tax-free benefit payments. This GRIST includes a summary of IRS guidance identifying a variety of fixed-indemnity designs (often paired with a wellness program) as improper double-dipping schemes. Employers evaluating such programs, which continue to emerge in the marketplace, should continue to exercise extreme caution and consult tax counsel.” MORE >>
Source: Mercer
Health & Welfare Plans
1 item“Rather than managing quality measure by measure, they are looking at the entire care transition as a single operational workflow. The goal is not simply to complete more outreach. It's to ensure every member receives the right intervention at the right time, supported by the information care teams need to act quickly. As CMS continues placing greater emphasis on outcomes and member experience, this connected approach is becoming increasingly important. Improving quality performance has never been solely about clinical expertise. More often, success depends on whether care managers know who needs attention, when they need it and what has changed in the member's care. Many plans still struggle” MORE >>
Source: Healthcare Dive
Litigation
2 items“As a threshold matter, the court had previously held, in a December 2025 ruling, that ERISA does not govern this Plan, because it is a Federal Reserve System benefit plan that falls outside ERISA’s coverage. Even so, the decision is instructive for ERISA disability claimants, because the court applied the same arbitrary-and-capricious standard and the same treating-physician and cherry-picking principles that federal courts apply in ERISA cases, relying on Black & Decker Disability Plan v. Nord, 538 U.S. 822 (2003), and on Second Circuit ERISA authority. Plaintiff, a former Federal Reserve Bank of New York employee, sought reinstatement of benefits after Matrix terminated them under the Plan” MORE >>
Source: Roberts Disability Law
“In Camp v. Lincoln National Life Insurance Company, No. 25-cv-06199-AMO, 2026 WL 2608200 (N.D. Cal. Sept. 3, 2026), Judge Araceli Martínez-Olguín of the United States District Court for the Northern District of California denied Plaintiff’s motion for judgment and granted Lincoln National’s motion for judgment under Federal Rule of Civil Procedure 52, upholding the denial of long-term disability benefits under an ERISA-governed group plan. Reviewing the claim de novo, the court concluded that Plaintiff failed to prove by a preponderance of the evidence that his tinnitus, hearing loss, and depression rendered him unable to perform his own occupation. What did Plaintiff have to prove under the” MORE >>
Source: Roberts Disability Law
General Benefits
3 items“The bill would add a new Section 215-d to the New York Labor Law that would extend requirements similar to the federal Older Workers Benefit Protection Act (OWBPA) to all severance agreements requiring employees to waive claims against their employer. Scope of Covered Agreements The bill targets what the legislature characterizes as “coercive severance ultimatums” and would apply when an employer offers an employee or former employee an agreement related to the individual’s separation from employment that requires the release of waivable claims. Unlike the OWBPA, which applies only to waivers of federal age discrimination claims by employees age 40 and older, the New York bill would apply re” MORE >>
Source: Littler
“Organizations could face low engagement and high turnover due to rising burnout and stress if employees continue to feel deprioritized. Jeri Doris explains how open communication, kindness and curiosity create a resilient people team that thrives in today’s evolving workplace.” MORE >>
Source: Employee Benefit News
“The Business of Health with Chip Kahn September 8, 2026 Video Audio Listen On: Apple Spotify YouTube Music Episode 14, AI Series: At the close of every episode, Chip asks his guests the same question: ‘What keeps you up at night?” MORE >>
Source: KFF
Webinars
1 item[Health & Welfare Plans]
Meeting the Moment: Helping People Navigate Change at Open Enrollment | Segal“Webinars and Events | September 2, 2026 As healthcare costs continue to rise, many organizations are facing difficult decisions about benefits design, cost sharing, and overall workforce well-being.” MORE >>
Source: Segal