The Daily Brief for Benefits Professionals
BenefitsWire
Health & Welfare Plans
June 25, 2026
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7 items · ~2 min read
Top of the Brief
What Plan Sponsors Need to Know About the Federal Independent Dispute Resolution (IDR) Operations Final Rules – Five Takeaways“By Allison B. Bans On May 28, 2026, the federal government issued Final Rules and a Fact Sheet that change how payment disputes between health plans and out-of-network providers are handled under the No Surprises Act’s (“NSA”) binding arbitration system.”
In this issue
Regulatory Action and Guidance (1) · ERISA Litigation (2) · Health & Welfare Plans (4)
Regulatory Action and Guidance
1 item“By Allison B. Bans On May 28, 2026, the federal government issued Final Rules and a Fact Sheet that change how payment disputes between health plans and out-of-network providers are handled under the No Surprises Act’s (“NSA”) binding arbitration system.” MORE >>
Source: swlaw.com
ERISA Litigation
2 items“The complaint alleges that Unum subsequently applied offsets and reductions that resulted in the plaintiff receiving less than the amount of benefits owed under the terms of the policy. The lawsuit contends that Unum's calculation of benefits violated the governing disability plan and improperly reduced income intended to protect the plaintiff after he became unable to work. The action seeks recovery of unpaid long-term disability benefits allegedly due under the Employee Retirement Income Security Act of 1974 ("ERISA"), together with any other relief available under the law.” MORE >>
Source: Roberts Disability Law
“In their opposition, Defendants argue that the eight challenged provisions of the 2027 NBPP final rule are authorized by the statute and are justified by current data and market conditions to address significant market failures. In addition, Defendants further contend that emergency relief is unwarranted because the Plaintiffs lack standing and have failed to demonstrate irreparable harm. ... Based on the court's current briefing schedule, Plaintiffs' reply is due by July 2, 2026, oral argument is set for July 8, 2026, and a ruling is expected in late July.” MORE >>
Source: Groom Law Group
Health & Welfare Plans
4 items“According to weight and cardiometabolic care platform Embla, GLP-1s currently cost employers $7,200 to $10,800 per employee per year. "For a self-funded employer with 1,000 employees and a conservative 5% obesity-eligible utilization rate, that's 50 employees on GLP-1s, costing anywhere from $360,000 to $540,000 annually in pharmacy spend alone — before administration, claims processing, or PBM fees," an article on Embla's site explains. ... 10% planning to drop GLP-1 coverage in 2027, according to a recent survey from nonprofit Business Group on Health.” MORE >>
Source: Employee Benefit News
[Regulatory Action and Guidance]
DOL, HHS, and Treasury Propose Rule Allowing Limited Excepted Benefits for Fertility Treatment under the ACA“The rule would allow insurance plans to offer separate fertility benefits coverage exempt from most ACA market reforms, essential health benefits requirements, and certain other federal law provisions. In these respects, fertility treatment coverage would be a distinct category, much like dental and vision coverage. ... some argue that the proposed rule may prompt certain employers that currently offer coverage to shift it to excepted benefits, reducing coverage for their workers.” MORE >>
Source: Hall Benefits Law
[Expert Analysis]
Virginia employers face two new paid leave laws“Virginia recently enacted two new paid leave laws – one requires covered employers to provide paid sick leave, and the other creates paid family and medical leave. Although these laws do not go into effect until 2027 and 2028, respectively, employers should begin preparing now.” MORE >>
Source: JD Supra
[Expert Analysis]
Mental Health Parity Enforcement 2026: State Regulations & Fines“Regulation Washington Medicaid ABA Reimbursement Splits in Two for 2026: Technician Pay Tracks the Region While Analyst Pay Lags. The January Apple Health Fee Schedule Sets 97153 at $12.” MORE >>
Source: acuity.news