The Affordable Care Act established the Patient-Centered Outcomes Research Institute (PCORI) to support research evaluating the effectiveness of medical treatments and healthcare delivery. To help fund this work, certain employer-sponsored health plans must pay an annual PCORI fee.
When employers think about fiduciary responsibility, retirement plans often come to mind first. But recent developments make it clear that fiduciary duties also matter—sometimes significantly—when it comes to employer-sponsored health and welfare plans.
Federal agencies have made mental health parity enforcement a top priority in 2026, and employers sponsoring group health plans are feeling the impact. Regulators are no longer satisfied with high‑level assurances that plans comply with the Mental Health Parity and Addiction Equity Act (MHPAEA). Instead, they expect detailed, data‑driven documentation showing that mental health and substance‑use‑disorder benefits are truly comparable to medical and surgical benefits. This includes not only the written plan design but also how rules are applied in real‑world scenarios.
Specialty drugs have been a major cost driver for years, but 2026 marks a significant shift in both scale and urgency. With GLP 1 medications expanding into new indications, gene therapies entering the market at record pace, and oncology drugs continuing to rise in both cost and utilization, specialty medications are projected to account for more than 60% of total pharmacy spending this year. That’s a dramatic change for employers, especially considering that specialty drugs represent fewer than 5% of total prescriptions.
As Marketplace health plan premiums rise and subsidies shift, employers are seeing more requests from employees (and their spouses) to drop Marketplace coverage and enroll in an employer-sponsored health plan mid-year. While this may feel straightforward, Marketplace rules and employer plan rules do not always work the same way.
Health benefit costs are projected to rise nearly 9% in 2026, putting significant pressure on employers to balance affordability with employee satisfaction. Against this backdrop, artificial intelligence (AI) is emerging as a transformative tool in the benefits space.
In our January issue, we outlined the major compliance themes shaping 2026. This month, we build on that foundation with a deeper look at the annual updates, effective dates, and action steps employers need as the new year begins.
Over the past two months, several major surveys — including the 2025 SHRM Employee Benefits Survey, the ADP TotalSource Employee Benefits Survey, and the 2025 National Benefits Survey — have painted a clear picture: employees are demanding more meaningful, more personalized, and more supportive benefits than ever before. Employers, facing a tight labor market and rising competition for talent, are responding by reshaping their benefits strategies around five core themes.
As 2025 closes, several pressing compliance issues will shape your responsibilities in 2026. Updated PCORI fees, Affordable Care Act (ACA) reporting obligations, state-level mandates, and new federal requirements such as gag clause attestations are all on the horizon.
As 2025 draws to a close, employers and benefits professionals face a shifting regulatory landscape that will shape health and welfare programs in 2026 and beyond. This year’s developments underscore the government’s dual priorities: expanding access, modernizing benefit delivery, and balancing compliance with practical flexibility. Below is a roundup of the most significant regulatory highlights.
