March 2026 Regulatory & Legislative Update

This regulatory and legislative update covers issues involving fiduciary duty, postmarking of benefit notices, vaccine schedules, and more.

Provider Directory – Fiduciary Duty

Recent litigation yet again highlights the importance of careful attention to fiduciary duty. The issue relates to the adequacy of health plan provider directories. Following is a brief overview of two such cases.

In Orrison v. Mayo Clinic, et. al., the plaintiff alleged that the defendants violated their obligations under ERISA and other federal laws in administering her health plan. Specifically, the plaintiff alleged that the defendants’ online search tool omitted in-network providers, forcing her to seek out-of-network mental health treatment for her son, resulting in significant costs. The plaintiff also stated she requested information on how non-network provider reimbursement rates were calculated so she could calculate costs. The plaintiff alleged the defendants refused to provide the necessary information. In addition, the plaintiff alleged that she was provided with false and conflicting information related to deductibles and out-of-pocket amounts.

Though the court dismissed many of the plaintiff’s claims, all of her claims related to the defendants’ alleged failures under the No Surprises Act and ERISA were allowed to proceed.

In another case, State of New York v. EmblemHealth, the state of New York sued EmblemHealth over ghost networks, alleging that the insurer maintained inaccurate directories and failed to provide adequate mental health coverage. The investigation revealed >80% of listed mental health providers were unavailable. A settlement was reached in this matter, and EmblemHealth will pay $2.5 million in penalties and restitution.

These cases offer another important reminder to group health plans to ensure their provider directories and databases are up-to-date and accessible. In addition, upon participant request for information related to out-of-network claims, group health plans should ensure they provide everything that ERISA and the No Surprises Act require.

As a reminder, the Consolidated Appropriations Act of 2021 requires health plans to maintain a public, online database of providers, verify provider directory information at least once every 90 days, update provider directories within two business days of receipt of updated information, and respond to inquiries regarding provider status within one business day. It is important to remember that state insurance laws may have additional requirements.

Health plan fiduciaries must be diligent in their efforts to make sure the applicable insurer, TPA, or other plan vendors are fulfilling these responsibilities.

Postmark Revisited

Benefit plan professionals are painfully aware that many benefit obligations are time sensitive. A few examples are COBRA notifications, Summary Plan Descriptions (SPDs) and Summary of Material Modification (SMM) delivery, roll-overs, and many, many more. Equally important, many participant actions are time sensitive, such as COBRA election, HIPAA special enrollment notification, and premium payment, to name just a few. 

Historically, when these types of notices or documents are mailed, the postmark date is deemed to be the date the item is in possession of the post office. This standard has been clarified to provide that the postmark, defined as a marking applied by the postal service to a mail piece, occurs when the piece is run through an automated sorting machine, which could be a day or more later than the date the post office takes possession of the document.

For time-sensitive items, this lag could create a late filing. Using electronic delivery for the communication avoids this unintended consequence, but electronic delivery is not always a viable or permissible option.  If mailing, do so well in advance of the due date. If the item is mailed on the last day or close to it, hand-deliver it to the post office and request that it be postmarked by hand stamp, or use other delivery methods that can validate the date.

For further information, see Federal Register: Postmarks and Postal Possession.

The Vaccine Conundrum

The Department of Health and Human Services (HHS) has made significant changes to the childhood immunization schedule, specifically reducing the number of routine, uniformly advised vaccinations from 17 to 11, sowing confusion for many. Why is this important for health plans? The Affordable Care Act requires health plans to cover, at no cost to the participant, certain defined preventive services. Among these are immunizations recommended by the Advisory Committee on Immunization Practices (ACIP).   

HHS recommendations notwithstanding, thus far, ACIP has not changed its list of required immunizations. Hence, health plans must continue to cover ACIP-recommended vaccines as preventive care. If the ACIP changes its recommendations, a plan would need to comply with any new requirement as of the first day of the plan year beginning one year after the change is made. Of course, a plan could continue to cover any preventive measure more generously than is mandated by the standards. 

With the ongoing changes and uncertainty surrounding vaccines, many states have passed or are considering insurance laws to preserve the preventive standards that the state deems to be appropriate. The takeaway for plan sponsors is to keep tabs on developments, but most importantly, make sure the terms of your health plan are followed.

Updated Notice of Privacy Practices

As a reminder, effective Feb. 16, 2026, all health plans and other Covered Entities subject to HIPAA must update their Notice of Privacy Practices (NPP). The HHS has provided a new model Notice of Privacy Practices. For additional information, see the February Benefit Beat.

New York City’s Notice of Employee Rights

Under New York City’s Earned Safe and Sick Time Act (now known as Protected Time Off law), employees have a right to protected time off. Employers must provide the written notice of protected time off rights to employees in his/her primary language upon commencement of employment.

On Feb. 19, 2026, the New York City Department of Consumer and Worker Protection (DCWP) issued an updated set of FAQs, as well as an updated Notice of Employee Rights that must be distributed to employees regularly working in New York City. 

The updated notice of employee rights addresses paid prenatal leave and the new unpaid sick leave and covered uses for sick leave that took effect on Feb. 22, 2026. See prior Benefit Beat article here. 

Additionally, employers must also post the notice in the workplace in an area that is visible and accessible to employees in English and in any other language employees in that workplace speak. The notice of employee rights is available in English and several other languages on the DCWP webpage.

The information contained in this Benefit Beat is not intended to be legal, accounting, or other professional advice, nor are these comments directed to specific situations. This information is provided as general guidance and may be affected by changes in law or regulation. This information is not intended to replace or substitute for accounting or other professional advice. You must consult your own attorney or tax advisor for assistance in specific situations. This information is provided as-is, with no warranties of any kind. CBIZ shall not be liable for any damages whatsoever in connection with its use and assumes no obligation to inform the reader of any changes in laws or other factors that could affect the information contained herein.