The Daily Brief for Benefits Professionals
BenefitsWire
Health & Welfare Plans
September 21, 2026
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5 items · ~2 min read
Top of the Brief
Second Circuit Confirms Providers Cannot Sue to Enforce NSA IDR Awards: Why That Matters for Your Group Health Plan’s Bottom Line“Yesterday, the Second Circuit handed down as significant decisions for self-insured group health plans, holding that the No Surprises Act (“NSA”) does not create a private right of action for out-of-network providers to enforce payment awards obtained through the independent dispute resolution (“IDR”) process. The ruling in East Coast Advanced Plastic Surgery, LLC v. Cigna Health and Life Insurance Company, No. 25-2204 (2d Cir. Sept. 17, 2026), joins the Fifth Circuit’s decision in Guardian Flight, L.L.C. v. Health Care Service Corp. to resolve the question: when a provider wins an IDR award and the plan doesn’t pay, can the provider go to court to collect? Now at least in the Second and Fif”
In this issue
Regulatory Action and Guidance (3) · Litigation (2)
Regulatory Action and Guidance
3 items“Employers must maintain a complete non-quantitative treatment limitations (“NQTLs”) comparative analysis covering all NQTLs despite the DOL’s announcement (see below) that it will focus enforcement on particular NQTLs. Employers remain subject to participant requests for disclosure of the full analysis (which must be provided within 30 days), private lawsuits challenging parity violations, and the DOL investigations prompted by participant complaints. Employers should work with their TPAs, insurers, and benefits counsel now to ensure a compliant analysis is in place. On September 8, 2026, the Employee Benefits Security Administration (the “EBSA”) issued Field Assistance Bulletin 2026-03 anno” MORE >>
Source: Haynes Boone
“On September 8, 2026, the Department of Labor’s Employee Benefits Security Administration (EBSA) issued Field Assistance Bulletin No. 2026-03 (FAB 2026-03 or the Bulletin), announcing a focused enforcement policy for the Mental Health Parity and Addiction Equity Act (MHPAEA). At the same time, EBSA also released a corresponding compliance tool intended to provide additional guidance on identifying and addressing common MHPAEA compliance issues. The tool provides a practical roadmap for plan sponsors and fiduciaries to evaluate, monitor, and address key parity requirements. As we discussed in previous posts (here and here), EBSA has made clear that barriers to mental health and substance use ” MORE >>
Source: Thompson Hine (ERISA Litigation & Compliance)
“Compliance News | September 18, 2026 The Federal IDR Team recently announced that prospective users of the independent dispute resolution (IDR) Gateway, a secure online platform for managing IDR disputes, can now register for an IDR Gateway account.” MORE >>
Source: Segal
Litigation
2 items“66 Franklin Street, Suite 300 Oakland, CA 94607 In Zayn v. Unum Life Insurance Company of America, No. 3:25-cv-01190-JR, 2026 WL 2719813 (D. Or. Sept. 15, 2026), United States Magistrate Judge Jolie A.” MORE >>
Source: Roberts Disability Law
“Yesterday, the Second Circuit handed down as significant decisions for self-insured group health plans, holding that the No Surprises Act (“NSA”) does not create a private right of action for out-of-network providers to enforce payment awards obtained through the independent dispute resolution (“IDR”) process. The ruling in East Coast Advanced Plastic Surgery, LLC v. Cigna Health and Life Insurance Company, No. 25-2204 (2d Cir. Sept. 17, 2026), joins the Fifth Circuit’s decision in Guardian Flight, L.L.C. v. Health Care Service Corp. to resolve the question: when a provider wins an IDR award and the plan doesn’t pay, can the provider go to court to collect? Now at least in the Second and Fif” MORE >>
Source: Thompson Hine (ERISA Litigation & Compliance)