Where we’re going

The recent decision in Tiara Yachts v. Blue Cross Blue Shield of Michigan highlights a growing legal threat facing employers that sponsor self-insured health plans. It sends a clear message to plan sponsors that they cannot assume their administrator is always acting in the best interest of the plan. More importantly, they cannot afford not … Continued

In California, an ACL surgery can cost $4,400 at one hospital or $63,800 at another—both using the same insurer and located just 75 miles apart. The only real difference is which contract applies and which facility performs the service. The care is the same. The billing is not. This is not a rare outlier. It’s … Continued

Insights from Christine Cooper, CEO aequum and Jack Towarnicky, member, aequum   As healthcare costs continue their upward climb, plan sponsors face intensifying pressure to manage expenses while maintaining quality benefits. Traditional PPO models, long relied upon for broad provider access, now contribute to unchecked cost growth. In the July/August 2025 issue of Benefits Magazine, … Continued

Why This Case Signals a Shift in Risk and Responsibility for Plan Sponsors A recent ruling by the Fifth Circuit in Guardian Flight v. Health Care Service Corporation sends a strong message to healthcare providers and plan sponsors alike: the courts will not step in to enforce payment of Independent Dispute Resolution (IDR) awards under … Continued

Author: Jack Towarnicky, Member, aequum I was recently asked for advice by someone who was adding HSA-capable coverage for the first time. Here is some of my response: I have a number of plan design and communication suggestions based on my 20+ years of experience with HSA capable coverage. Each situation is different. So, you … Continued

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

The 2025 Milliman Medical Index (MMI) estimates the average cost of employer-sponsored health coverage for a family has reached $35,000. That’s not a forecast, it’s the new reality. If you’re an employer offering health coverage, this number isn’t surprising. You’ve been watching premiums rise year after year while absorbing the majority of the increased premium … Continued

The House has spoken and Health Savings Accounts (HSAs) are getting an upgrade. The “One Big, Beautiful Bill,” recently passed by the House, includes a list of HSA-related provisions designed to expand eligibility, increase flexibility and boost tax-advantaged savings potential. These are the first significant changes in almost two decades – since President George W. … Continued

The IRS has announced new Health Savings Account (HSA) contribution limits for 2026, offering an opportunity to save more. While that’s positive for eligible participants, most employees won’t benefit. Many don’t have access to an HSA-qualified plan and those who do often fail to use it in ways that maximize its long-term financial advantages. The … Continued

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