Benefits plans and their sponsors are always under tremendous pressure to comply with rules and regulations, but recent market and political developments have only intensified the pressure. Here are seven crucial takeaways — and ways to respond — from HUB’s 2026 Compliance & Benefits Update webinar:
- Cost pressures are real and must be addressed
- Review high-cost claims data and drug spending trends at your next renewal.
- Evaluate cost management options — captives, ICHRAs, reference-based pricing, narrow networks — through a compliance lens.
- Work with your HUB advisor to model the cost and compliance implications of each strategy for your specific workforce.
Healthcare costs rose significantly in 2026, driven by increasing pharmacy costs (specialty drugs, GLP-1s, cell and gene therapies), provider cost-shifting from Medicaid and Affordable Care Act (ACA) subsidy reductions and market consolidation.
What to do next:
- Remember that fiduciary responsibility extends to health plans
- Consider establishing a cross-functional benefits committee to oversee vendor selection and document decision-making.
- Conduct formal requests for proposals (RFPs) for PBM and other major vendor relationships.
- Have outside counsel review PBM agreements, particularly around anti-spreading provisions and audit rights.
- Consider extending fiduciary liability insurance to your health and welfare plans.
Class-action lawsuits targeting self-insured employers over pharmacy benefits manager (PBM) fees, pharmacy pricing and the reasonableness of fees pose a new litigation risk to ERISA-covered health and welfare plans.
What to do next:
- Federal PBM transparency rules are on the way
- Begin reviewing PBM agreements immediately to identify terms that may need renegotiation before 2029.
- Engage your PBM or carrier about their compliance roadmap for the new requirements.
- Watch for regulatory guidance and sample notice templates expected within the next 18 months.
- Understand whether state PBM legislation impacts your self-funded plan.
Effective 2029, the Consolidated Appropriations Act of 2026 (CAA 2026) will require new PBM disclosures for all employers, prohibit PBM spread pricing and expand plan sponsor audit rights. The U.S. Department of Labor (DOL) also proposed new PBM compensation disclosure rules in January 2026 for ERISA self-funded and level-funded plans.
What to do next:
- The OBBBA opens new plan design opportunities
- Evaluate telehealth cost-sharing and whether adjustments make sense for your plan and workforce.
- Assess whether DPC is a viable option given your workforce’s locations and plan structure; verify any DPC provider arrangement meets the statutory fee limits ($150 a month per individual, $300 a month per family).
- If you adopt the new $7,500 DCFSA limit, amend the plan and model nondiscrimination testing risk.
- Download HUB’s OBBBA 2026 Readiness Checklist for a full implementation guide.
Enacted in July 2025, the One Big Beautiful Bill Act (OBBBA) made three major changes: telehealth is now permanently Health Savings Account (HSA)-compatible pre-deductible; Direct Primary Care (DPC) can now be paired with high-deductible health plans (HDHP) and HSA; and the Dependent Care Flexible Spending Account (DCFSA) limit is now $7,500, up from $5,000.
What to do next:
- ACA compliance requires attention annually
- Recalculate affordability under your chosen safe harbor using the new 9.96% threshold.
- Confirm ACA reporting is on track by distributing Form 1095s by March 2 and e-filing with the IRS by March 31.
- If you have employees in California, Massachusetts, New Jersey, Rhode Island or the District of Columbia, confirm state-specific filing deadlines and requirements with your carrier or ACA reporting vendor.
The 2026 affordability safe harbor increased to 9.96% (up from 9.02%), giving employers more flexibility in employee premium contributions while still meeting the affordability standard. But ACA penalties saw their largest single-year increase in history (15%), reaching up to $3,340 per employee for failure to offer coverage and up to $5,010 per employee for an unaffordable offer of coverage.
What to do next:
- Don’t overlook fundamentals
- HIPAA: Distribute updated Notices of Privacy Practices reflecting changes related to disclosure of substance use disorder records by April 17.
- Mental Health Parity: Conduct or update your non-quantitative treatment limitations (NQTL) comparative analysis — statutory obligations remain despite the federal non-enforcement policy applicable to the final regulations; fully insured plans should request and retain a copy from their carrier.
- Prescription Drug Data Collection (RxDC) Reporting: Determine reporting obligations and respond promptly to any questionnaires from your insurer or TPA — prescription drug data is due June 1.
- Gag Clause Attestation: Complete your annual attestation via the HIOS portal by December 31.
Several foundational requirements have 2026 deadlines that are easy to miss amid big-picture planning.
What to do next:
- AI in benefits: Opportunity requires governance
- Implement a formal AI governance policy covering data use, vendor standards and human oversight.
- Ask vendors specific questions about how protected health information (PHI) and personally identifiable information (PII) are managed within their AI systems.
- Ensure human review remains part of any AI-driven claims or benefits decisions.
Artificial intelligence (AI) is expanding rapidly across benefits administration, including enrollment platforms, chatbots, claims processing and more. But some AI-assisted claim denials have resulted in litigation, and data privacy risks are growing.
What to do next:
Compliance is not a constraint on strategy — it’s what makes strategy sustainable. The most successful employers in 2026 will build innovative plan designs on a strong foundation of compliance.
Contact HUB International’s employee benefits specialists to discover how forward-thinking organizations are turning compliance into a competitive advantage.