Newsroom

Federal law mandates health plans to report premium costs, drug use, and spending via the CAA’s RxDC program. Carriers handle reporting for insured plans, but employers may need to assist. This 2026 overview covers carrier approaches, surveys, deadlines, and where employer input is required.

January sets the tone for group health plan compliance and employee understanding. This column covers annual group size determinations, year-long settings, and why January is perfect for reinforcing benefits education as employees tackle new deductibles and rising health care costs.

Curious about the CAA’s Gag Clause Attestation? This column covers why it exists, how it promotes transparency, and which plans must file by December 31. Fully insured employers have minimal responsibility, while self-funded and level-funded plans face distinct obligations.

Clients often need to access Rx benefits before receiving their health plan ID Cards. Our handy Small Group Rx BIN and PCN table can provide the information they need.

The ACA’s annual Special Open Enrollment Window runs 11/15 – 12/15, giving Small Group employers a one-month opportunity to enroll in medical coverage without meeting participation or contribution requirements. Learn what this means for 2026 coverage and what to keep in mind when submitting cases.

The Affordable Care Act requires Medical Loss Ratio rebates when health plans fall short of required minimum spending on care and activities to improve the quality of care. Get details on 2024 rebates due in September in Paul Roberts’s new column.

California’s infertility and IVF mandate for fully insured plans just got a last-minute extension to January 1, 2026. The Legislature approved the change via a late-June budget trailer bill. Here’s what benefits professionals need to know about the delay — and what hasn’t changed.