https://ethosbenefits.com/learn Plain-English guides and commentary for employers on health plans: ERISA, ACA reporting, self-funding, stop-loss, PBMs, compliance and fiduciary duty. en-us Thu, 12 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/choosing-an-employee-benefits-broker https://ethosbenefits.com/insights/choosing-an-employee-benefits-broker How to choose an employee benefits broker, what to ask about pay and conflicts, and why a fiduciary standard of care matters for your health plan. Insight Fiduciary duty and advisor pay Donovan Ryckis Thu, 12 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/erisa-health-plan-litigation https://ethosbenefits.com/insights/erisa-health-plan-litigation ERISA health plan lawsuits over drug prices, PBM contracts, tobacco surcharges and voluntary benefits. What each case alleges, where it stands, and what to do. Insight Fiduciary duty and advisor pay Donovan Ryckis Thu, 12 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/how-to-lower-healthcare-costs https://ethosbenefits.com/insights/how-to-lower-healthcare-costs How employers can lower healthcare costs without raising deductibles, from pharmacy and large claims to site of care, and what Kalos Services did. Insight Benefits strategy and administration Donovan Ryckis Thu, 12 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/consolidated-appropriations-act-2021 https://ethosbenefits.com/insights/consolidated-appropriations-act-2021 What the Consolidated Appropriations Act of 2021 requires of employer health plans, from broker pay disclosure to gag clause and RxDC filings, and what to ask. Insight Compliance rules and deadlines Donovan Ryckis Thu, 12 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/why-is-health-insurance-so-expensive https://ethosbenefits.com/insights/why-is-health-insurance-so-expensive Why employer health insurance costs so much, from hidden prices and commissions to closed plans with no data, and what an employer can change this year. Insight Benefits strategy and administration Donovan Ryckis Thu, 12 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/health-insurance-renewal-increase https://ethosbenefits.com/insights/health-insurance-renewal-increase What to do when your health insurance renewal comes in with an increase, and how Axiom Healthcare Services turned a 2.6% increase into a 13% decrease. Insight Benefits strategy and administration Donovan Ryckis Thu, 12 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/summary-of-benefits-and-coverage https://ethosbenefits.com/benefits-101/summary-of-benefits-and-coverage Every employer with a group health plan must give employees a summary of benefits and coverage (SBC), a standardized summary of what each plan option covers and costs, no longer than four double-sided pages. It is due with enrollment materials, 30 days before an automatic renewal, within 90 days for special enrollees, and within seven business days of a request. Benefits 101 Compliance rules and deadlines Donovan Ryckis Wed, 04 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/transparency-in-coverage-final-rule https://ethosbenefits.com/insights/transparency-in-coverage-final-rule The Transparency in Coverage final rule adds a signed attestation to plan pricing files in March 2027. Key dates, what changes and TPA contract fixes to make. Insight Compliance rules and deadlines Donovan Ryckis Wed, 04 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/cfo-fiduciary-playbook https://ethosbenefits.com/insights/cfo-fiduciary-playbook A health plan fiduciary playbook for CFOs. What to measure, what to ask your advisor and vendors, and how a committee and a 3 to 5 year plan fit in. Insight Fiduciary duty and advisor pay Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/aca-reporting https://ethosbenefits.com/benefits-101/aca-reporting ACA reporting is the yearly filing that tells the IRS what health coverage an employer offered or provided. Employers with 50 or more full-time employees, including equivalents, file Forms 1094-C and 1095-C. Insurers and small self-insured employers file Forms 1094-B and 1095-B. Returns are due February 28 on paper or March 31 electronically. Benefits 101 ACA reporting Chelsea Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/aca-reporting-software https://ethosbenefits.com/benefits-101/aca-reporting-software ACA reporting software helps an applicable large employer track full-time status, code Forms 1095-C, check affordability and e-file Forms 1094-C and 1095-C with the IRS. You can buy it as a payroll or HRIS module, a standalone ACA tool, or a full-service filing. Whichever you pick, the employer stays legally responsible for what is filed. Benefits 101 ACA reporting Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/ai-in-employee-benefits https://ethosbenefits.com/insights/ai-in-employee-benefits Where AI helps employers run benefits in 2026, where it falls short, and the HIPAA rules, including business associate agreements, that limit its use. Insight Benefits strategy and administration Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/broker-compensation-disclosure https://ethosbenefits.com/benefits-101/broker-compensation-disclosure Broker compensation disclosure is a written statement that brokers and consultants to ERISA group health plans must give the employer when they expect $1,000 or more in pay. Required by section 202 of the Consolidated Appropriations Act, 2021, it lists their services and all direct and indirect compensation before the contract is signed, extended or renewed. Benefits 101 Fiduciary duty and advisor pay Chelsea Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/evidence-of-insurability-invoice-issues https://ethosbenefits.com/insights/evidence-of-insurability-invoice-issues How evidence of insurability (EOI) for life and disability coverage causes invoice errors and denied claims, and how employers can audit and fix the process. Insight Benefits strategy and administration Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/health-plan-benchmarking-mistake https://ethosbenefits.com/insights/health-plan-benchmarking-mistake Withholding claims data when you benchmark or market your health plan leads to weak bids and bigger increases later. Why full disclosure gets better offers. Insight Benefits strategy and administration Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/employee-benefits-administration https://ethosbenefits.com/benefits-101/employee-benefits-administration Employee benefits administration is the work of keeping an employer's benefits running correctly all year. It covers enrollment and eligibility, sending enrollment data to carriers, matching payroll deductions and invoices to that data, processing life events, and handing off to COBRA and ACA reporting. Most problems start with eligibility data that doesn't match. Benefits 101 Benefits strategy and administration Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/employee-benefits-management https://ethosbenefits.com/benefits-101/employee-benefits-management Employee benefits management is the ongoing oversight an employer gives its benefits program after the plan is designed. It covers vendor monitoring against contracts and service levels, the renewal cycle, a compliance calendar, employee communication and advocacy, claims and utilization review, and regular benefits committee meetings, so problems surface early instead of at renewal. Benefits 101 Benefits strategy and administration Chelsea Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/employee-benefits-survey-questions https://ethosbenefits.com/benefits-101/employee-benefits-survey-questions A good employee benefits survey asks employees whether they know their benefits, how satisfied they are, whether the cost feels worth it, how easy the plan is to use and what they would change. Use 25 to 35 questions, mostly rating scales, run it anonymously four to six months before renewal, and never ask about health conditions. Benefits 101 Benefits strategy and administration Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/employee-benefits-trends https://ethosbenefits.com/insights/employee-benefits-trends The employee benefits trends that will shape 2027 health plan decisions, from premium growth and GLP-1 costs to PBM reform, parity and price transparency. Insight Benefits strategy and administration Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/erisa-bond-cost https://ethosbenefits.com/benefits-101/erisa-bond-cost ERISA bond cost is the premium a Treasury-listed surety charges for the bond, and no law sets that price. It depends mostly on the bond amount, which ERISA fixes at 10% of the plan funds each person handles, at least $1,000 and at most $500,000, or $1,000,000 for plans holding employer securities. Benefits 101 ERISA and plan documents Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/erisa-bond https://ethosbenefits.com/benefits-101/erisa-bond An ERISA bond is a fidelity bond that ERISA section 412 requires for every fiduciary and other person who handles a benefit plan's funds or property. It protects the plan against theft, fraud and other dishonest acts, and must cover at least 10% of the funds handled, with a $1,000 minimum and a $500,000 cap per plan. Benefits 101 ERISA and plan documents Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/erisa-vs-non-erisa https://ethosbenefits.com/benefits-101/erisa-vs-non-erisa ERISA plans are health and welfare plans that private employers sponsor, and they must follow federal rules on plan documents, disclosure, fiduciary duties and claims. Non-ERISA plans, mainly government plans, church plans and qualifying voluntary employee-paid insurance, are exempt from ERISA and are governed mostly by state law, with disputes heard in state court. Benefits 101 ERISA and plan documents Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/erisa-wrap-document https://ethosbenefits.com/benefits-101/erisa-wrap-document An ERISA wrap document is a written plan document that wraps around your insurance carriers' policies and certificates and adds the provisions ERISA requires that carrier documents leave out, such as the named fiduciary, funding, amendment procedures and claims rules. It can combine several benefits into one plan and often doubles as the summary plan description. Benefits 101 ERISA and plan documents Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/1095-a-vs-1095-c https://ethosbenefits.com/benefits-101/1095-a-vs-1095-c Form 1095-A comes from the Health Insurance Marketplace and reports Marketplace coverage and any advance premium tax credit, and the person who enrolled needs it to file Form 8962 with their tax return. Form 1095-C comes from an applicable large employer, reports the coverage offered to a full-time employee, and is not needed to file. Benefits 101 ACA reporting Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/1095-b-vs-1095-c https://ethosbenefits.com/benefits-101/1095-b-vs-1095-c Form 1095-B shows that a person had minimum essential health coverage, and it comes from insurers, government programs and small self-insured employers. Form 1095-C comes from applicable large employers, those with 50 or more full-time employees including equivalents, and shows the coverage offered to each full-time employee, what it cost and, for self-insured plans, who enrolled. Benefits 101 ACA reporting Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/glp-1-coverage https://ethosbenefits.com/insights/glp-1-coverage How employers are deciding GLP-1 coverage for 2027, which benchmarks fit your size, the numbers that should drive the decision, and four plan designs. Insight Pharmacy and PBMs Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/health-plan-claims-data-access https://ethosbenefits.com/insights/health-plan-claims-data-access S. 2355 would give employer health plans a legal right to their own claims data and audits. Where the bill stands, what it requires and what to do now. Insight Compliance rules and deadlines Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/self-funded-health-insurance https://ethosbenefits.com/benefits-101/self-funded-health-insurance Self-funded health insurance is a health plan where the employer pays employees' medical claims from its own money instead of buying a fully insured policy. A third-party administrator processes the claims, a pharmacy benefit manager runs the drug benefit, and stop-loss insurance reimburses the employer when claims pass set limits. Benefits 101 Plan financing Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/stop-loss-insurance https://ethosbenefits.com/benefits-101/stop-loss-insurance Stop-loss insurance reimburses a self-funded employer when health claims pass a set limit. Specific stop-loss covers one person's claims above a per-person deductible, and aggregate stop-loss covers total plan claims above a group-wide cap. The employer pays claims up to those attachment points, and the carrier reimburses the excess. Benefits 101 Stop-loss insurance Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/stop-loss-insurance-cost https://ethosbenefits.com/benefits-101/stop-loss-insurance-cost Stop-loss insurance cost depends on your group, so there is no standard price. Carriers quote specific stop-loss per employee per month by single and family tier, and aggregate coverage separately. The specific deductible, contract type, group size, claims history, lasers, industry, plan design, medical trend and commissions all move the premium. Benefits 101 Stop-loss insurance Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/how-to-choose-a-pbm https://ethosbenefits.com/benefits-101/how-to-choose-a-pbm To choose a good PBM, an employer should compare contracts, not just price quotes. Check how brand, generic and specialty drugs are defined, what share of rebates reaches your plan, whether spread pricing is allowed, and your audit, data and termination rights. A standardized, scored RFP makes the bids comparable. Benefits 101 Pharmacy and PBMs Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/how-to-vet-benefits-vendors https://ethosbenefits.com/insights/how-to-vet-benefits-vendors Four tests employers can run on any benefits vendor before signing, from who carries the liability to whether the fee is reasonable under ERISA 408(b)(2). Insight Benefits strategy and administration Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/level-funded-vs-fully-insured https://ethosbenefits.com/benefits-101/level-funded-vs-fully-insured In a fully insured plan, the employer pays a fixed premium and the insurer carries all claims risk. A level-funded plan is a self-funded plan with fixed monthly payments for administration, a claims fund and stop-loss insurance. The employer may get back part of any unused claims fund, but takes on more compliance duties and contract risk. Benefits 101 Plan financing Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/level-funded-vs-self-funded https://ethosbenefits.com/benefits-101/level-funded-vs-self-funded A level-funded plan is a self-funded plan sold as a bundle: one carrier sets a fixed monthly payment that covers administration, a claims fund and stop-loss. In a traditional self-funded plan, the employer pays claims as they occur and picks its own TPA, PBM and stop-loss carrier, gaining control and data but taking on more cash flow risk. Benefits 101 Plan financing Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/mark-cuban-wake-up-call-for-employers https://ethosbenefits.com/insights/mark-cuban-wake-up-call-for-employers Mark Cuban says self-funded employers' sickest workers fund their drug rebates. What his Cost Plus Drug Company shows employers about pharmacy pricing. Insight Pharmacy and PBMs Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/mlr-rebates https://ethosbenefits.com/benefits-101/mlr-rebates An employer that receives an MLR rebate must give employees the share that came from their premium contributions. Under DOL Technical Release 2011-04, that share is a plan asset and should be used within three months, as a premium holiday, reduced contributions, cash or benefit enhancements. The employer may keep only the share its own contributions paid for. Benefits 101 Compliance rules and deadlines Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/medical-vs-pharmacy-benefits https://ethosbenefits.com/benefits-101/medical-vs-pharmacy-benefits The medical benefit and the pharmacy benefit are two ways your health plan pays for care. The medical benefit, run by your carrier or TPA, pays for drugs a provider gives in a clinic or hospital and bills after the visit. The pharmacy benefit, run by a PBM, pays for prescriptions filled at a pharmacy, in real time. Benefits 101 Pharmacy and PBMs Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/medicare-part-d-creditable-coverage https://ethosbenefits.com/benefits-101/medicare-part-d-creditable-coverage Medicare Part D creditable coverage is employer drug coverage expected to pay at least as much as standard Medicare Part D. Employers must tell Medicare-eligible members each year, before October 15, whether their plan is creditable, and report it to CMS. For 2027, the simplified test requires a plan designed to pay at least 73 percent of drug costs. Benefits 101 Compliance rules and deadlines Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/mental-health-parity-nqtl https://ethosbenefits.com/benefits-101/mental-health-parity-nqtl An NQTL, or nonquantitative treatment limitation, is a non-numeric limit on benefits, such as prior authorization, step therapy or network admission standards. Since February 10, 2021, group health plans covering mental health or substance use disorder benefits must keep a written comparative analysis of each NQTL and produce it when regulators or participants ask. Benefits 101 Compliance rules and deadlines Chelsea Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/pbm-reform https://ethosbenefits.com/insights/pbm-reform Federal PBM reform passed in the Consolidated Appropriations Act, 2026. What it requires of PBMs and employer plans, when it starts, and what to do now. Insight Pharmacy and PBMs Chelsea Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/pbm-spread-pricing https://ethosbenefits.com/benefits-101/pbm-spread-pricing Spread pricing is when a pharmacy benefit manager charges your health plan more for a prescription than it pays the pharmacy and keeps the difference. The spread rarely appears on an invoice. Your contract decides whether it is allowed, and federal law passed in 2026 requires PBMs to report it to employer plans starting in 2028 or 2029. Benefits 101 Pharmacy and PBMs Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/pharmacy-benefits-administrator https://ethosbenefits.com/benefits-101/pharmacy-benefits-administrator A pharmacy benefits administrator (PBA) processes prescription claims and runs a drug plan for an employer, usually for an administrative fee, while the plan keeps more of the decisions. A PBM often bundles those services with its own rebate deals, network and pharmacies. The label matters less than the contract: verify pay, rebates and data access in writing. Benefits 101 Pharmacy and PBMs Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/rxdc-reporting https://ethosbenefits.com/benefits-101/rxdc-reporting RxDC reporting is the yearly prescription drug and health care spending report that group health plans and insurers must send CMS under section 204 of the Consolidated Appropriations Act, 2021. Each report covers the prior calendar year and is due June 1. Carriers, TPAs and PBMs usually file most of it, but employers often supply the premium data. Benefits 101 Compliance rules and deadlines Chelsea Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/section-105h-nondiscrimination-testing https://ethosbenefits.com/benefits-101/section-105h-nondiscrimination-testing Section 105(h) nondiscrimination testing checks that an employer's self-insured medical reimbursement plan, including a self-funded health plan, HRA or health FSA, does not favor highly compensated individuals in eligibility or benefits. If the plan fails, the plan stays in place, but some or all reimbursements to those individuals become taxable income to them. Benefits 101 Compliance rules and deadlines Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/self-funded-vs-fully-insured https://ethosbenefits.com/benefits-101/self-funded-vs-fully-insured In a fully insured plan, the employer pays a fixed premium and the insurance company carries the claims risk. In a self-funded plan, the employer pays employees' claims itself, usually with stop-loss insurance capping large losses, and in exchange gets its own claims data, freedom from most state mandates and any money not spent on claims. Benefits 101 Plan financing Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/self-funded-health-insurance-pros-and-cons https://ethosbenefits.com/benefits-101/self-funded-health-insurance-pros-and-cons Self-insured health plans give employers control of plan design, full claims data, freedom from state premium taxes and mandates, and the chance to keep money when claims run low. The cons are claims volatility, uneven cash flow, exposure to large claims and lasering, fiduciary and compliance duties, and run-out liability when the plan ends. Benefits 101 Plan financing Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/self-funded-healthcare-trusts https://ethosbenefits.com/benefits-101/self-funded-healthcare-trusts A healthcare trust is a separate legal account that holds a self-funded health plan's money apart from the employer's general assets, for use only on plan benefits and expenses. Most self-funded plans don't need one. A trust, such as a VEBA, adds ERISA bonding, a Form 5500 at any size and, at 100 or more participants, an audit. Benefits 101 Plan financing Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/stop-loss-captive https://ethosbenefits.com/benefits-101/stop-loss-captive A captive health insurance plan is a self-funded employer health plan whose stop-loss coverage runs through a captive, an insurer owned by the employers it covers. The employer pays routine claims, a shared captive layer pays mid-sized large claims, and a reinsurer pays the biggest ones. Good years can return surplus; bad years can cost more. Benefits 101 Stop-loss insurance Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/stop-loss-examples https://ethosbenefits.com/benefits-101/stop-loss-examples A self-funded employer with a $50,000 specific deductible pays the first $50,000 of one person's claims, and stop-loss reimburses the rest. If that person's claims reach $220,000, the carrier pays $170,000. Aggregate stop-loss works the same way for total plan claims above a group-wide attachment point. Benefits 101 Stop-loss insurance Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/tennessee-sb-420 https://ethosbenefits.com/insights/tennessee-sb-420 Tennessee SB 420 and HB 870 would have widened the state's copay assistance rules. The bills did not pass. What they proposed and what it means for employers. Insight Compliance rules and deadlines Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/2027-maternity-billing-changes https://ethosbenefits.com/insights/2027-maternity-billing-changes New CPT maternity codes start January 1, 2027, and Medicare's payment values are still proposed. What changes, what is final, and what employers should do. Insight Benefits strategy and administration Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/aca-affordability-safe-harbor https://ethosbenefits.com/benefits-101/aca-affordability-safe-harbor An ACA affordability safe harbor lets an employer prove its coverage is affordable without knowing household income. The employee's cost for the cheapest self-only plan with minimum value must stay at or below the IRS percentage, 9.96% for 2026 plan years and 10.22% for 2027, of W-2 wages, rate of pay or the federal poverty line. Benefits 101 ACA reporting Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/benefits-dirty-dozen https://ethosbenefits.com/insights/benefits-dirty-dozen Twelve common health plan practices that quietly raise employer costs, from fee basis swaps to PBM spread pricing, with the question to ask about each. Insight Fiduciary duty and advisor pay Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/department-of-labor-audit https://ethosbenefits.com/insights/department-of-labor-audit What a Department of Labor (EBSA) health plan investigation reviews, what triggers one, what investigators ask for, and how plan sponsors can prepare now. Insight Fiduciary duty and advisor pay Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/vertical-integration-in-healthcare https://ethosbenefits.com/insights/vertical-integration-in-healthcare Insurers own PBMs, PBMs own pharmacies and hospitals buy practices. What vertical integration in healthcare costs employers and how to protect your plan. Insight Pharmacy and PBMs Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/employee-benefit-plan-audit https://ethosbenefits.com/benefits-101/employee-benefit-plan-audit An employee benefit plan audit is an independent accountant's audit of an ERISA plan's financial statements, attached to the Form 5500. Plans with 100 or more participants generally need one, but fully insured and unfunded health plans are exempt at any size. Health plans that hold assets in a trust, such as a VEBA, must be audited. Benefits 101 ERISA and plan documents Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/employee-benefits-strategy https://ethosbenefits.com/benefits-101/employee-benefits-strategy An employee benefits strategy is a written plan, usually covering three to five years, for what your benefits must do for your employees and your budget, and how you will get there. It is built from claims data, workforce needs, budget, market benchmarks and compliance duties, owned by a committee, and measured against targets every quarter. Benefits 101 Benefits strategy and administration Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/employee-wellness-program https://ethosbenefits.com/benefits-101/employee-wellness-program An employee wellness program is an employer program that encourages healthier habits, often with rewards or premium discounts. Programs tied to a group health plan must follow federal wellness rules: participatory programs have no reward cap, while health-contingent rewards are capped at 30% of coverage cost, or 50% for tobacco programs. Benefits 101 Benefits strategy and administration Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/employer-healthcare-coalition https://ethosbenefits.com/insights/employer-healthcare-coalition What an employer healthcare coalition is, why vendors listen to employers who ask together, and five plays any mid-market employer can run this year. Insight Benefits strategy and administration Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/erisa-compliance-checklist https://ethosbenefits.com/benefits-101/erisa-compliance-checklist An ERISA compliance checklist lists what an employer health and welfare plan must have, send and file. That means a written plan document and SPD, SMMs, SARs, SBCs, Form 5500, claims procedures, a documented fiduciary process, broker and consultant fee disclosures, COBRA and other required notices, and the CAA 2021 filings, each on its own deadline. Benefits 101 ERISA and plan documents Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/form-5500-deadline https://ethosbenefits.com/benefits-101/form-5500-deadline Form 5500 is due the last day of the 7th month after the plan year ends, which is July 31 for calendar-year plans. The 5500 extension deadline is 2½ months later, October 15 for calendar-year plans, if you file Form 5558 by the original due date. An extended corporate tax return can also extend it automatically. Benefits 101 ERISA and plan documents Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/gag-clause-attestation https://ethosbenefits.com/benefits-101/gag-clause-attestation A gag clause attestation is a yearly statement most group health plans must file with CMS by December 31, confirming their contracts with insurers, TPAs, networks and other service providers do not block the plan from getting or sharing its own cost, quality and claims data. Your TPA can file it, but the duty stays with your plan. Benefits 101 Compliance rules and deadlines Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/health-plan-fiduciary-committee https://ethosbenefits.com/benefits-101/health-plan-fiduciary-committee A health plan fiduciary committee is a group an employer formally appoints to make and record decisions about its group health plan, such as choosing vendors, reviewing fees and deciding appeals. ERISA does not require one, but it judges fiduciaries by their process, and a committee with a charter and minutes is how an employer shows that process. Benefits 101 Fiduciary duty and advisor pay Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/multi-cancer-early-detection-test https://ethosbenefits.com/insights/multi-cancer-early-detection-test An FDA panel backed the Galleri multi-cancer early detection test. What the vote means for employer health plans, cost, coverage and member messaging. Insight Benefits strategy and administration Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/pcori-fee https://ethosbenefits.com/benefits-101/pcori-fee The PCORI fee is a yearly federal fee on health insurers and on employers that sponsor self-insured health plans, including level-funded plans and HRAs. It is the average number of covered lives times the IRS rate, $3.84 for plan years ending October 2025 through September 2026, and is reported and paid on Form 720 by July 31. Benefits 101 Compliance rules and deadlines Chelsea Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/summary-plan-description https://ethosbenefits.com/benefits-101/summary-plan-description A summary plan description (SPD) is the plain-language document ERISA requires every employer plan to give participants, explaining what the plan covers, who is eligible, how to file claims and appeals, and their rights under ERISA. It is due within 90 days after someone joins the plan and must match the plan document. Benefits 101 ERISA and plan documents Chelsea Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/year-end-health-plan-compliance-checklist https://ethosbenefits.com/benefits-101/year-end-health-plan-compliance-checklist A year-end health plan compliance checklist lists the filings, notices, tests and limit updates an employer group health plan has to finish before the plan year closes and early in the next. It covers the December 31 gag clause attestation, nondiscrimination testing, new plan limits, participant notices, ACA reporting and the CMS Part D disclosure. Benefits 101 Compliance rules and deadlines Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/third-party-administrator https://ethosbenefits.com/benefits-101/third-party-administrator A third party administrator (TPA) is a company an employer hires to run its self-funded or level-funded health plan. The TPA pays claims with the employer's money, provides network access, files stop-loss claims and reports plan data. The employer, not the TPA, carries the claims risk and stays responsible for the plan. Benefits 101 Benefits strategy and administration Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/voluntary-benefits-fiduciary-duty https://ethosbenefits.com/benefits-101/voluntary-benefits-fiduciary-duty Employers can owe fiduciary duties on voluntary benefits even when employees pay the full premium. A voluntary program stays outside ERISA only if it meets all four conditions of the DOL safe harbor, including no employer endorsement. Miss one, and the employer must select and monitor carriers and broker pay like any other ERISA plan. Benefits 101 Fiduciary duty and advisor pay Chelsea Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/voluntary-benefits https://ethosbenefits.com/benefits-101/voluntary-benefits Voluntary benefits are optional coverages employees choose and usually pay for themselves through payroll deduction, at group rates the employer makes available. Common examples are accident, critical illness, hospital indemnity, supplemental life, disability and pet insurance. The employer picks the menu and runs the deductions, and each employee decides whether to enroll. Benefits 101 Benefits strategy and administration Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/what-happens-behind-the-scenes-with-your-health-insurance https://ethosbenefits.com/insights/what-happens-behind-the-scenes-with-your-health-insurance Where an employer's health plan premium dollar goes, where costs hide in networks, PBMs and claims, and the plan data federal law says you can get. Insight Benefits strategy and administration Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/aggregate-stop-loss https://ethosbenefits.com/benefits-101/aggregate-stop-loss Aggregate stop-loss insurance reimburses a self-funded employer when the plan's total claims for the year pass a group-wide cap called the aggregate attachment point. That cap is usually expected claims times a corridor, such as 125 percent. The employer pays claims up to the cap, and the carrier reimburses the excess. Benefits 101 Stop-loss insurance Chelsea Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/form-1095-b https://ethosbenefits.com/benefits-101/form-1095-b Form 1095-B is an IRS information return showing which months a person and their covered family members had minimum essential health coverage. Insurers, government programs such as Medicaid and Medicare, and small employers with self-insured plans issue it. People don't attach it to a federal return, but it can prove coverage for a state mandate. Benefits 101 ACA reporting Chelsea Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/form-1095-c https://ethosbenefits.com/benefits-101/form-1095-c Form 1095-C is the IRS form an applicable large employer, one with 50 or more full-time employees including equivalents, gives each full-time employee to report the health coverage it offered that employee each month and the cost of the cheapest employee-only option. Employees do not need it to file their taxes, but should keep it. Benefits 101 ACA reporting Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/level-funded-health-insurance https://ethosbenefits.com/benefits-101/level-funded-health-insurance Level-funded health insurance is a self-funded health plan with a fixed monthly payment. The payment covers a claims fund, stop-loss insurance and administration. If claims come in under the fund, the employer may get part of the surplus back, but it takes on self-insured compliance duties and contract risk at renewal and termination. Benefits 101 Plan financing Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/reference-based-pricing https://ethosbenefits.com/benefits-101/reference-based-pricing Reference-based pricing (RBP) lets a self-funded health plan pay providers a set percentage of a benchmark, usually what Medicare pays for the same service, instead of a network discount off billed charges. It can lower claim costs, but providers who reject the payment may balance bill members, so the plan must resolve those bills. Benefits 101 Plan financing Chelsea Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/obbba-employer-health-plans https://ethosbenefits.com/insights/obbba-employer-health-plans The One Big Beautiful Bill Act changed HSA rules, the dependent care FSA limit and other benefits. What took effect, when, and what IRS guidance says. Insight Compliance rules and deadlines Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/health-plan-data-privacy-ai https://ethosbenefits.com/insights/health-plan-data-privacy-ai What HIPAA and ERISA require when a health plan vendor wants to train AI on claims data, and five contract questions to ask before you sign or renew. Insight Compliance rules and deadlines Donovan Ryckis Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/who-is-subject-to-erisa https://ethosbenefits.com/benefits-101/who-is-subject-to-erisa ERISA applies to almost every health and welfare plan sponsored by a private-sector employer or union, whatever the company's size and whether the plan is insured or self-funded. Government plans, most church plans, plans kept only to comply with workers' compensation, unemployment or disability laws, plans abroad for nonresident aliens, and unfunded excess benefit plans are exempt. Benefits 101 ERISA and plan documents Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/insights/health-plan-renewal-timeline https://ethosbenefits.com/insights/health-plan-renewal-timeline A month-by-month health insurance renewal timeline for employers, from claims review 12 months out to open enrollment and the notices due before January 1. Insight Benefits strategy and administration Meghan Anderson Tue, 03 Nov 2026 00:00:00 GMT https://ethosbenefits.com/benefits-101/broker-of-record-letter https://ethosbenefits.com/benefits-101/broker-of-record-letter An employer uses a broker of record letter to tell an insurance carrier which broker now represents its plan. Signed by an authorized officer, it moves the account to a new broker without replacing the policy itself, and it stays in effect until the employer rescinds it in writing. Benefits 101 Fiduciary duty and advisor pay Donovan Ryckis Fri, 30 Oct 2026 00:00:00 GMT