Author: Kendra L. Roberson

Kendra Roberson utilizes nearly two decades of experience to design and implement health and welfare plans, retirement plans, executive compensation agreements and equity compensation plans. Kendra has deep knowledge of health and welfare plan compliance issues and provides creative solutions to implementing increasing regulations affecting those plans. Kendra has represented public companies, tax-exempt organizations universities and governments in these areas. She has experience representing clients before the Internal Revenue Service, Department of Labor and the Pension Benefit Guaranty Corporation.

New Proposed Rules Would Allow Employers to Offer Fertility Benefits as “Excepted Benefits” Outside Their Major Medical Plans

On May 13, 2026, the Departments of Treasury, Labor, and Health and Human Services jointly published proposed regulations that would establish a new category of “limited excepted benefits” for fertility-related coverage under Employee Retirement Income Security Act of 1974 (ERISA), the Internal Revenue Code, and the Public Health Service Act. If finalized, these rules would create a streamlined pathway for employers to offer separate fertility coverage (on an insured or self-insured basis) to employees who are not otherwise enrolled in the employer’s primary group health plan. The fertility “excepted benefits” would be generally exempt from Affordable Care Act’s mandates (such as requirements to cover certain preventive care services), HIPAA portability rules, the No Surprises Act, and certain other federal mandates that apply to traditional group health plans. If finalized, the regulations would be effective for plan years beginning on or after January 1, 2027.

What the Proposed Rules Would Do

The proposed regulations would permit employers to offer fertility benefits — covering diagnosis, mitigation, or treatment of infertility or infertility-related reproductive health conditions — as a standalone insured or self-insured benefit separate from major medical coverage. Covered services could include diagnostic lab tests, imaging, hormone panels, in vitro fertilization (IVF), intrauterine insemination (IUI), fertility medications, surgical procedures, and preconception care.

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DOL Proposes New PBM Fee Disclosure Rules

On January 30, 2026, the Department of Labor (DOL) published proposed regulations that would require pharmacy benefit managers (PBMs) to disclose direct and indirect compensation that PBMs (and their affiliates, agents, and subcontractors) receive in connection with providing pharmacy benefit management services (or advice, recommendations, and referrals regarding such services) to self-insured group health plans. If an employer has engaged a third-party administrator to provide services, including pharmacy benefit management services, for its self-insured group health plan, the third-party administrator is responsible for obtaining the required information from the PBM and disclosing it to the employer.

The DOL proposal would not apply the disclosure obligations with respect to governmental plans, small employer health reimbursement arrangements, or fully insured group health plans, although the DOL may revisit its application to fully insured plans in future rulemaking.

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Five Habits of the Healthy Health Plan Fiduciary

As it is often said, “the only constant in the world is constant change,” so it is important for health plan fiduciaries to periodically review the fundamentals for consistency and compliance to avoid risk and costly mistakes. Below is a Health Plan Fiduciary Checklist with five (5) actions that health plan fiduciaries can take to help keep your organization safe and successful.

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Deadline Approaches for Employers to Post Machine-Readable Files on a Public Website

The July 1st deadline is quickly approaching for non-grandfathered group health plans and issuers to publicly disclose, in accordance with the Transparency in Coverage Final Rules, price information in machine-readable files for the plan year beginning on or after January 1, 2022. The two machine-readable files must show (1) in-network negotiated provider rates for covered items and services and (2) out-of-network allowed amounts and billed charges for covered items and services.

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