BenefitsWire

“The proposed rules put the Working Families Tax Cuts’ Premium Tax Credit reforms into effect which strengthen eligibility checks, close gaps in the verification process, and help ensure taxpayer-funded subsidies go only to eligible American taxpayers. The Trump Administration’s Task Force to Eliminate Fraud exposed the need for stronger safeguards to protect the integrity of the Federal Marketplace.” MORE >>

Source: IRS

“On September 8, 2026, the U.S. Department of Labor's Employee Benefits Security Administration (EBSA) issued Field Assistance Bulletin No. 2026-03 (Bulletin 2026-03), narrowing near-term enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA) to three priority areas and confirming nonenforcement of the 2024 Final Rule's newer provisions pending litigation. The administration has also stopped defending that rule in court and promised a substantially revised proposal by December 31, 2026. Congress is moving the other way: bipartisan legislation to expand DOL's enforcement authority is pending in the House, and the Senate HELP Committee is poised to scrutinize any administrati” MORE >>

Source: National Law Review

“The Employee Benefit Security Administration (EBSA) has issued Field Assistance Bulletin (FAB) 2026-03 together with an updated enforcement guidance document “Identifying Potential Problems: If You See the Following in Your Health Plan.” Treatment limitations and benefit exclusions Medical necessity standards and utilization management practices Network adequacy and provider access While these three points are the focus, the EBSA reserves the right to investigate other issues. The EBSA also issued an enforcement guidance tool to help plans and issuers comply with their obligations under MHPAEA, including the NQTL comparative analyses requirements.” MORE >>

Source: CBIZ

“The Departments of Labor, Health and Human Services, and the Treasury have issued final regulations updating the Transparency in Coverage rules for participant cost-sharing disclosures and machine-readable files. Cost-sharing disclosures (for plan years beginning on or after January 1, 2027). The final regulations change the participant cost-sharing disclosures that employer-sponsored group health plans must provide. Among other changes, plans must now make these disclosures available by phone, using the telephone number listed on the plan’s ID cards. The new requirements apply to plan years beginning on or after January 1, 2027.” MORE >>

Source: Haynes Boone

“The Employee Benefits Security Administration (EBSA), a division of the U.S. Department of Labor (DOL), recently issued guidance for employer health plans on compliance with federal mental health and substance use disorder parity laws. However, litigation over the rules remains ongoing in a D.C. federal court, though it has been stayed since May 2025. EBSA’s new field assistance bulletin provides what it bills as a narrower enforcement framework. The agency notes that it has declined to enforce the 2024 rules, but it will enforce the 2013 final rules.” MORE >>

Source: Hall Benefits Law

“On October 14, 2026, HHS published a notice delegating to the CMS Administrator the Secretary’s authority to impose permissive exclusions under section 1128(b) of the Social Security Act. The delegation is effective immediately and preserves the existing delegation to HHS’s Office of Inspector General. The notice also ratifies prior actions taken under the delegated authority. The delegation gives CMS a more direct role in excluding individuals and entities from federal health care programs for certain misconduct. Exclusion generally bars federal health care program payment for items and services furnished by an excluded individual or entity, including under Medicare Advantage and Part D, an” MORE >>

Source: Groom Law Group

“On October 13, 2026, the en banc Eleventh Circuit held in Bolton v. Inland Fresh Seafood Corporation of America that ERISA does not require plaintiffs to exhaust a plan’s internal claims procedures before suing in federal court for breach of fiduciary duty or other statutory violations. The ruling overturns four decades of precedent that had made the Eleventh Circuit the only circuit to require exhaustion of statutory ERISA claims. For plan sponsors and fiduciaries sued in Alabama, Florida, and Georgia, the decision removes a common early-dismissal defense and aligns the Eleventh Circuit with most other circuits.” MORE >>

Source: Proskauer

“On October 1, 2026, Democrats on House Education and Workforce Committee, including that committee’s ranking member, Bobby Scott (D-VA), took the other side of this issue, introducing three separate bills that would effectively overrule court decisions that have limited the sorts of cases participant plaintiffs can bring against ERISA fiduciaries. In this article, we very briefly summarize these new proposals and conclude with discussion of their prospects and implications. No more deference to plan committee’s benefit determinations/plan interpretations: The Employee and Retiree Access to Justice Act would end courts’ current practice of deferring to plan fiduciaries’ decisions “with respec” MORE >>

Source: October Three

“Nonetheless, read on to learn about (1) what happens if you are a plan fiduciary, you don’t pay premiums to keep the plan’s insurance coverage in force, and the Department of Labor gets involved (Sonderling v. Sills); (2) preliminary approval of an $850k class action settlement involving alleged mismanagement of the Hess Corporation’s 401(k) plan (Wagner v. Hess); (3) the invalidation of Illinois-law arbitration awards because they were preempted by ERISA (Cigna v. Laboratory Physicians); (4) a case ruling that while ERISA might require investment policy statements to be produced on request, it didn’t matter here because plaintiffs lacked standing to complain about it (Phillips v. CAES); and” MORE >>

Source: yourerisawatch.com

“In Cude v. Lincoln National Life Insurance Company, No. 8:25-cv-00123-AH-KESx, 2026 WL 3036131 (C.D. Cal. Oct. 9, 2026), District Judge Anne Hwang of the United States District Court for the Central District of California addressed whether a general release that a claimant signed to settle an employment dispute barred his later ERISA claim for short-term disability benefits. The court held that it did not, denied the defendant Wells Fargo & Company Short-Term Disability Plan’s motion for summary judgment, and granted Plaintiff summary judgment on the Plan’s release defense. The sequence of dates drove the result.” MORE >>

Source: Roberts Disability Law

[Health & Welfare Plans]

“The PFML law (Conn. Gen. Stat. §§ 31-49e to 30-49t), enacted in 2019, expands the existing Connecticut Family and Medical Leave Act (CT FMLA) (Conn. Gen. Stat. §§ 31-51kk to 31-51rr), which provides many of the same job protections as the federal FMLA. Coinciding with the start of benefit availability in 2022, the PFML law broadens existing CT FMLA definitions for eligible employees and family members, among other amendments. The PFML program covers all employers with one or more Connecticut employees. Self-employed individuals or sole proprietors may opt into the program. Private elementary and secondary schools are exempt, along with public employers subject to a collective bargaining agre” MORE >>

Source: Mercer

“Employers that sponsor health and welfare plans for their employees rarely run them alone. They hire insurers, third-party administrators, and other service providers to process claims, calculate benefits, make claims decisions, answer participant questions, update plan participants, and keep the plan running day to day.” MORE >>

Source: Lasher