Where we’re going

The stop-loss insurance market is facing a stress test. After several years of relatively stable trends, a wave of high-dollar claims has triggered significant losses, rate hikes and tighter underwriting. For employers with self-insured health plans, this shift brings serious consequences. They face higher stop-loss premiums, increased claim scrutiny, fewer coverage guarantees and in some … Continued

Fifteen years after the passage of the Affordable Care Act (ACA), the results are in and so are the consequences. While health reform succeeded in reducing the number of uninsured Americans, it failed to address the cost of employer-sponsored health coverage. For the more than one hundred sixty million Americans who get their health coverage … Continued

The No Surprises Act (NSA) was created to protect patients from unexpected medical bills—especially in emergencies and when treated by out-of-network providers at in-network facilities. However, recent layoffs at the federal agency responsible for enforcement have put those protections at risk. With fewer regulators and mounting dispute volume, oversight is weakening, leading to more billing … Continued

At this year’s Disability Management Employer Coalition (DMEC) Compliance Conference in Columbus, Ohio, aequum’s Jack Towarnicky offered insight on two mental health topics: Mental Health in the Workplace and The Mental Health LTD Challenge: Because Parity is Not a Priority … Yet. These conversations confirmed that employers, plan sponsors and disability management administrators can no … Continued

I read with interest Ben Dobler’s February 5, 2025, article on “Why Health Savings Accounts (HSAs) Aren’t Always Worth the ‘Triple Tax Savings’[i]. Ben notes that HSAs require individuals to be covered by a “High Deductible Health Plan” which has tradeoffs compared to traditional coverage. However, my 20+ years of hands-on experience with HSA-capable coverage … Continued

The No Surprises Act (NSA) was created to protect patients from a number of surprise medical bills — such as for emergency treatment by out-of-network providers at in-network facilities. However, recent layoffs at the federal agency responsible for enforcement may have put those protections at risk. With fewer regulators and mounting dispute volume, oversight is … Continued

The Consumer Financial Protection Bureau (CFPB) has taken bold steps to curb the impact of medical debt on consumers, including efforts to eliminate medical debt from credit reports and crack down on abusive billing practices. As the political landscape shifts, the future of these protections grows increasingly uncertain. This change creates risk for self-insured health … Continued

A high-profile lawsuit involving JPMorgan Chase is putting employers on alert that managing a self-insured health plan now comes with serious legal risk. Even responsible companies can be sued if they’re not actively controlling healthcare costs. In this case, JPMorgan employees claim the company mismanaged its prescription drug benefits by selecting a pharmacy benefit manager … Continued

Health insurance claim denials are on the rise, creating new challenges for patients, employers and plan sponsors. Behind many of these denials are layers of administrative complexity—such as prior authorization requirements, coding errors and insurers’ cost-cutting tactics that often block or delay payment for legitimate medical services. In 2023, nearly 20% of claims submitted to … Continued

The latest Healthcare Price Transparency Executive Order reaffirms the federal government’s commitment to ensuring that hospitals and insurers disclose actual healthcare costs rather than vague estimates. This action aims to empower patients and create a more competitive market for consumers using health care services. However, plan sponsors and providers may garner greater value from those … Continued