Insights

There are a few different notice requirements in play when an employer makes a midyear change to benefits. First, ERISA includes a summary of material modification (SMM) requirement. The SMM requirement pertains to material changes in a group health plan. ERISA does not define “material,” but this term would generally refer to any information or changes that impact the rights or obligations of plan participants and beneficiaries. Such changes may include, but are not limited to, changes in plan

On April 16, 2026, Gov. Reynolds signed HF 2434, which prohibits insurers from denying coverage for covered services solely because the referring primary care provider does not participate in the insurer’s network. The legislation also prohibits an insurer from imposing higher deductibles, copayments, or coinsurance for covered services referred by an out-of-network primary care provider compared to the cost-sharing charged for services referred by an in-network primary care provider. An insure

On April 14, 2026, Gov. Moore signed HB637/SB385, dubbed the “Vax Act,” which requires insurers to cover preventive care items and services recommended by the Maryland Secretary of Health without imposing cost-sharing requirements. The law requires the health secretary to obtain an analysis from the Maryland Health Care Commission and provide a public notice-and-comment period before any recommendation becomes effective. Once the secretary issues a recommendation, insurers must provide coverage

On April 14, 2026, Gov. Moore signed a pair of laws expanding coverage requirements for health insurers: HB393/SB272 requires insurers that provide coverage for chemotherapy to also provide coverage for scalp cooling systems used to prevent or reduce hair loss in connection with chemotherapy to treat cancer. For the full text of HB393/SB272, please see this legislative text. HB1094/SB910 requires insurers that provide benefits for certain counseling services to provide reimbursement for thos

On March 30, 2026, the DOL, HHS, and Treasury (the departments) disclosed in a court filing that they will no longer defend the mental health parity regulations they issued in September 2024. Instead, the departments indicated that they intend to propose replacement regulations by the end of the year. The disclosure comes nearly a year after the departments announced an indefinite pause on enforcement of the 2024 mental health parity regulations – but not the prior 2013 regulations or the under

On April 6, 2026, CMS issued a final rule updating several Medicare program regulations. Among other changes, the final rule excludes all account-based plans from Part D creditable coverage reporting. Group health plan sponsors who offer prescription drug coverage to people eligible for Part D (such as employees, retirees, COBRA participants, and beneficiaries) must inform these individuals and CMS whether their coverage is deemed creditable. CMS noted that account-based plans, such as Health R

On March 16, 2026, Gov. Reeves signed HB 565, which requires group health plans to provide coverage for biomarker testing for a wide variety of purposes, including diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee’s disease or condition. Coverage is required when biomarker testing is supported by medical and scientific evidence. In addition, the law requires insurers to provide specific written justifications if coverage for biomarker testing is denied and furth

On April 2, 2026, in Barbich et al v. Northwestern University et al, an Illinois district court found that the plaintiffs sufficiently alleged that defendant Northwestern University (Northwestern) breached its ERISA fiduciary duties by mismanaging their group health plan benefits. The court denied the defendants’ motion to dismiss and ordered Northwestern to formally answer the complaint. Employers should be aware of this development, which marks a departure from rulings in several ot

On April 6, 2026, Gov. Spanberger signed a pair of laws prohibiting health insurers from imposing certain treatment limitations: HB736 limits the frequency with which an insurer may require prior authorization for prescription drugs. Under the law, once a prior authorization request is approved, the duration of an initial authorization must be no less than six months, and the duration of a continued authorization must be no less than 12 months. An insurer may not revoke an authorization unless