The Daily Brief for Benefits Professionals
BenefitsWire
Health & Welfare Plans
October 16, 2026
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9 items · ~2 min read
In this issue
Regulatory Action and Guidance (3) · Health & Welfare Plans (2) · Litigation (2) · General Benefits (2)
Regulatory Action and Guidance
3 items“Seyfarth Synopsis: The Departments of Labor, Treasury, and Health and Human Services (the “Departments”) have finalized significant revisions to the Transparency in Coverage regulations (the “Amendments”).” MORE >>
Source: CMS
“Date: August 4, 2026 From: Peter Nelson, Deputy Administrator and Director, Center for Consumer Information & Insurance Oversight Subject: Guidance on Standardized Plan Options and Non-Standardized Plan Options Limits and Exceptions for Plan Year 2027.” MORE >>
Source: CMS
“Plans may use proprietary clinical guidelines, the bulletin says, as long as the standards applied to mental health and substance use benefits are comparable to, and no more stringent than, those applied to medical and surgical benefits. Plans and their service providers must provide the guidelines on request, both during investigations and to participants. Network adequacy, specifically admission standards and provider reimbursement methodologies, rounds out the list. When participants cannot find in-network treatment, the bulletin notes, they either pay out-of-network costs or go without care. EBSA said it may also investigate other limitations as issues arise, particularly when participan” MORE >>
Source: hrbuzz.com
Health & Welfare Plans
2 items“The news comes as employers prepare for nearly double-digit health insurance price increases and many plan to shift some of those costs to workers. Walmart, too, is increasing employees’ shares of the health insurance, with premiums rising $1.” MORE >>
Source: HR Dive
“It’s that time of year again – employers are gearing up for the administrative marathon known as open enrollment season, when employees revisit their benefit plan choices for the upcoming plan year.” MORE >>
Source: JD Supra
Litigation
2 items“In a significant change to ERISA litigation in the Eleventh Circuit, the court this week held en banc that participants bringing statutory ERISA claims—including claims for breach of fiduciary duty—need not exhaust a plan’s internal claims procedures before filing suit. In Bolton v. Inland Fresh Seafood Corp. of America, Inc., the court overruled its forty-year-old decision in Mason v. Continental Group, Inc. Under Mason, the Eleventh Circuit was the only circuit to extend the administrative exhaustion requirement beyond claims for benefits due under an ERISA plan, where courts consistently require exhaustion, to an across-the-board requirement for all statutory ERISA claims.” MORE >>
Source: Gibson Dunn
“Quick Hits In Fresenius USA Manufacturing, Inc. v.” MORE >>
Source: Ogletree Deakins
General Benefits
2 items“Nobody in your health plan’s supply chain loses money when your employees get sicker. That fact explains why the PwC Health Research Institute now projects a 9% commercial cost trend for 2027, the highest in 17 years.” MORE >>
Source: Employee Benefit News
“and organizations across industries will need to understand what comes next. Join Foley & Lardner for a timely post-election briefing that goes beyond the headlines to examine the results, the new balance of power in Congress, and the Trump Administration’s likely response.” MORE >>
Source: Foley & Lardner