The deadline for filing the 2025 annual reporting form (ARF) for the San Francisco Health Care Security Ordinance (HCSO) is May 1, 2026. The HCSO requires, among other items, that covered employers report on their total healthcare expenditures for employees for each quarter in 2025. As background, employers with at least one employee within the city of San Francisco who works more than 8 hours per week for more than 90 days are required to spend a certain amount (called an expenditure) on healthcare for their covered employees. These funds can be used for employer-sponsored medical, dental or vision insurance, paid to the city, or contributed toward programs that reduce employee out-of-pocket healthcare costs.

On March 2, 2026, the U.S. Department of Labor (DOL) announced that it would be extending the public comment period for its proposed rule, Improving Transparency Into Pharmacy Benefit Manager Fee Disclosure, from March 31 to April 15. This proposed rule, published on January 30, 2025, would add new disclosure obligations for pharmacy benefit managers (PBMs), PBM consultants and other advisors providing PBM-related services to self-insured group health plans (see our eAlert here). The DOL press release states that extending the comment period will allow stakeholders the opportunity to address aligning the proposed rule with the PBM requirements set out in the Consolidated Appropriations Act of 2026. 

On March 10, 2026, in the case of DaVita Inc. v. Marietta Memorial Hospital Employee Benefit Plan, et. al., a federal district court for the Southern District of Ohio held that an employer-sponsored, self-insured health plan’s decision to classify all dialysis providers as “out-of-network,” resulting in lower reimbursement, did not constitute disparate treatment based on a health factor, and thus, did not violate HIPAA’s nondiscrimination rules. Although the Supreme Court had already rejected DaVita’s Medicare Secondary Payer claim, the trial court separately considered whether the policy unlawfully discriminated against participants with end-stage renal disease (ESRD). The court concluded that the plan design of keeping dialysis providers out-of-network was, on its face, neutral and that the evidence did not show the employer adopted the dialysis carve‑out with discriminatory intent, but rather as a permissible cost‑containment measure. As a result, the remaining claims made under HIPAA, as well as the claims made under ERISA, were dismissed, reinforcing plan sponsors’ ability to structure benefits for legitimate business reasons when properly documented.

On March 19, 2026, in State of Oregon et. al. v. Kennedy et. al., a federal judge of the United States District Court for the District of Oregon indicated that he would partially grant an order to invalidate a December 2025 declaration issued by the Secretary of the Department of Health and Human Services (HHS), Robert F. Kennedy Jr. Widely known as “the Kennedy Declaration,” it called into question the medical validity and safety of gender affirming care for children and adolescents and threatened to bar hospitals and providers who provide gender affirming care to minors from participating in Medicare, Medicaid and other federal healthcare programs. The judge agreed with the arguments set forth by the plaintiff states and determined that the declaration, which established standards of medical care that superseded existing standards, was unlawful because it exceeded HHS’s statutory authority. Further, he affirmed that the Kennedy Declaration amounted to a substantive modification to the law which could only be adopted following notice-and-comment rulemaking, which had not occurred. A formal written opinion from the Court is expected in the coming weeks. HHS will likely appeal the decision.

On March 20, 2026, in Greene et. al. v. Progressive Corp., a federal judge for the U.S. District Court for the Northern District of Ohio dismissed a tobacco cessation and COVID vaccine premium surcharge lawsuit for its failure to state a claim. The lawsuit was brought by current and former employees of Progressive Corp. (Progressive) who had paid a tobacco and/or COVID vaccine premium surcharge to maintain coverage under Progressive’s Health, Life and Disability Plan (the “Plan”). They alleged that the Plan’s tobacco and COVID vaccine wellness programs violated ERISA’s antidiscrimination provisions because the company did not retroactively reimburse surcharges for employees who met an alternative standard mid-year, thus failing to provide the “full reward,” and because the plan documents failed to adequately disclose the availability of a reasonable alternative standard for the removal of the surcharge. The Plaintiffs also alleged a fiduciary breach claim, alleging that Progressive mishandled plan assets by improperly retaining the surcharge amounts. The Court dismissed the complaint, holding that 1) Progressive was not required to retroactively reimburse the surcharge; 2) Progressive’s notice of their reasonable alternative standard was compliant with applicable requirements; and 3) fiduciary standards did not apply to the challenged conduct, which involved implementing non-discretionary plan terms.  There has recently been an uptick in the number of similar lawsuits challenging the imposition of premium surcharges on tobacco users. While Courts have been split on this issue, the Ohio court’s decision, along with other recent decisions, may suggest a shift in favor of employers and plan sponsors.

On March 9, 2026, the U.S. District Court for the Southern District of New York issued a ruling in Stern v. JP Morgan Chase & Co. (“Stern”) that allows JP Morgan (“JPM”) employees to proceed with core portions of their ERISA lawsuit. The suit alleges that their employer mismanaged prescription-drug costs under the company’s self-insured health plan.

In her decision, the judge dismissed claims that JPM breached fiduciary duties of loyalty and prudence, stating that relationships and decisions for JPM as a bank do not inherently become fiduciary acts exclusively because JPM is also the plan sponsor, and that those allegations were challenges to plan design rather than fiduciary conduct. However, the judge allowed the employees’ prohibited transaction claims to proceed, keeping the litigation alive. These claims allege that JPM had engaged in an unlawful prohibited transaction with CVS Caremark by paying its unreasonably high fees.

While this is not a final decision on the merits of the claims against JPM, the decision underscores increasing scrutiny on employer oversight of PBMs and comes as similar ERISA lawsuits are brought against large employers and plan sponsors across the country.

By February 16, 2026, all HIPAA covered entities must update their HIPAA Notice of Privacy Practices (NPPs) pertaining to the confidentiality of substance use disorder (SUD) treatment records in accordance with the February 16, 2024 final regulation under 42 CFR Part 2 (the “Final Rule”). While the U.S. District Court for the Northern District of Texas vacated (invalidated) the Final Rule’s provisions pertaining to increased privacy protections for the confidentiality and disclosure of PHI related to reproductive healthcare (see our eAlert here), the ruling did not vacate requirements pertaining to SUD treatment records. The ruling also does not prohibit covered entities from retaining language in their NPPs providing increased protections for reproductive healthcare records if they so choose. Employers and plan sponsors should consult with their trusted advisors to ensure that all required updates to the NPPs are completed by the February 16, 2026 deadline. This should include making a determination as to whether to retain language in the NPPs regarding reproductive healthcare.

On January 15, 2026, President Trump announced the Great Healthcare Plan, a broad healthcare initiative that promises to lower drug prices and insurance premiums, hold large insurance companies accountable, and maximize price transparency. The Plan proposes to lower drug prices by codifying the administration’s Most-Favored-Nation deals and making more drugs available over the counter. It calls for sending subsidy payments directly to eligible Americans to allow them to purchase insurance of their choice, funding a cost-sharing reduction program, and ending kickbacks to lower insurance premiums. It aims to hold insurance companies accountable by requiring them to publish rate and coverage comparisons, costs of overhead vs. claim payments, claim denial rates, and wait times. Finally, the Plan calls for maximum transparency and seeks to require any provider or insurer who accepts Medicare or Medicaid to post their pricing and fees to avoid surprise billing. It will now be up to Congress to pass this framework into law.

On December 23, 2025, a series of lawsuits were filed in U.S district courts in Illinois and New York against several national employers and their benefits brokers, including United Airlines, Laboratory Corp. of America Holdings, Gallagher Benefit Services Inc., Mercer Health and Benefits Administration LLC, Lockton Companies LLC, and Willis Towers Watson US LLC. The lawsuits allege that the employers and their brokers are plan fiduciaries and that they breached their fiduciary duties by failing to negotiate prices and ensure prudent processes by monitoring broker commissions and loss ratios for voluntary benefits, such as accident and critical illness insurance, causing the plaintiffs to pay higher premiums for these benefits. Further, the suits allege that the plan sponsors engaged in self-dealing with their benefit brokers which resulted in higher premiums. While these voluntary benefits are not traditionally subject to ERISA, as they fall under the “voluntary plan safe harbor” (an ERISA exemption), the suits argue that certain actions by the employer removed these benefits from the safe harbor protection, and thus, subjected them to ERISA. Specifically, the suits allege many actions taken by the plan sponsors constitute “endorsing the plan,” as defined under ERISA, but argue that the action that cements these voluntary plans as subject to ERISA is the inclusion of these benefits on their Form 5500s.

Copies of these Complaints:
Brewer v. CHS/Community Health Systems, Inc.
Braham v. Laboratory Corp of America Holdings
Fellows v. Universal Services of America, LP
Pimm v. United Airlines, Inc.
Article in PSCA: New Wave of ERISA Litigation Targets Voluntary Benefits

Effective December 19, 2025, the U.S. Department of Labor (DOL) modified its Delinquent Filer Voluntary Compliance Program (DFVCP), which allows plan administrators to voluntarily submit overdue annual Form 5500 reports while paying lower civil penalties. This modification expanded penalty relief to multiple employer welfare arrangements (MEWAs) and Entities Claiming Exemption (ECEs) who are required to file the Form M-1. Eligible MEWAs and ECEs who wish to participate in the DFVCP must file a complete Form M-1 for the most recent filing year via the DOL’s EFAST site and pay the $750 penalty amount by submitting electronic payment via the gov.pay link on the DOL’s website.