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"high-cost
Uncategorized

Stop-Loss Insurers Increasingly ‘Lasering’ High-Cost Claimants

by Inoventive Solutions
June 9, 2026

As million-dollar health insurance claims continue to surge, stop-loss insurers that provide excess coverage for self-insured employers are increasingly using a controversial underwriting tactic to limit coverage for high-cost claimants.

The tactic, called “lasering,” entails applying a higher deductible or exclusion to a specific individual or condition, like heart failure or cancer. Instead of the normal attachment point applying uniformly across the group, the insurer carves out higher-risk individuals and shifts more financial responsibility back to the employer.

The trend is accelerating as more employees and dependents generate extremely costly claims tied to cancer treatments, specialty drugs, complex surgeries and chronic illnesses. According to a recent analysis by Sun Life, claims exceeding $1 million increased 29% between 2024 and 2025 and have surged 61% over the last four years.

That growth is reshaping the stop-loss market and creating new challenges for employers that self-fund their health plans.

How lasering works

Under a traditional stop-loss arrangement, an employer may absorb the first $100,000 or $150,000 of an employee’s claims before stop-loss coverage begins reimbursing expenses above that threshold. The stop-loss carrier reimburses the employer’s plan, not the employee.

But with lasering, a stop-loss carrier may impose a $500,000 deductible on an employee undergoing cancer treatment, instead of the same attachment point used for all other workers on the plan.

There are several types of stop-loss lasers:

Standard lasers — Apply a higher attachment point to all claims associated with a specific individual.

Contingent lasers — Apply only to claims tied to a specific diagnosis or condition, such as cancer or diabetes.

Limited contract basis lasers — Restrict the time frame during which certain claims are covered.

Exclusion lasers — Remove a specific individual from stop-loss coverage entirely.

What’s behind the trend

Stop-loss carriers say the growing use of lasering is being driven by rising claims severity and improved predictive analytics.

Advanced claims modeling tools now allow insurers to analyze medical histories, pharmacy utilization and treatment trends with far greater precision. As a result, insurers are requesting more detailed claims information during underwriting and using that data to identify participants likely to generate catastrophic claims.

Employer effects

For employers, lasering may reduce stop-loss premiums, but it can also create substantial financial risks if a lasered employee incurs major expenses. Employers may unexpectedly assume hundreds of thousands of dollars in additional costs for a single claimant.

As a result, some self-insured employers may have to set aside more in reserves and consider increasing employee cost-sharing to account for the added risk.

Also, employers and brokers are increasingly negotiating for “no new laser” provisions during renewals. These provisions limit an insurer’s ability to add new lasers during or after renewal based on emerging claims.

There are other ways to prevent or reduce the need for a laser. We can help you understand your options, workforce demographics, medical claims history and potential financial liability.

"HSA"/
Uncategorized

2027 HSA Contribution, HDHP Cost-Sharing Limits

by Inoventive Solutions
June 2, 2026

The IRS has announced slightly higher health savings account contribution limits for 2027, with the limit increasing 2.3% for individual HSA plans.

The IRS updates HSA contribution limits annually, along with minimum deductibles and out-of-pocket maximums for high-deductible health plans. HSAs help employees save for medical expenses and are only available to those enrolled in qualified HDHPs.

Understanding these amounts now can help you get an early start on human resources planning for next year.

Here are the changes coming in 2027:

HSA annual contribution limit

Plan2027 limit2026 limit
Self-only$4,500$4,400
Family$9,000$8,750
Catch-up contribution (for aged 55 and older)$,1000$,1000

HDHP minimum annual deductible

Plan2027 limit2026 limit
Individual$1,750$1,700
Family$3,500$3,400

HDHP annual out-of-pocket maximum

Plan2027 limit2026 limit
Individual$8,700$8,500
Family$17,400$17,000
Maximum employer excepted-benefit HRA contribution$2,250$2,200

What to do

If you sponsor an HDHP for your staff, review the plan’s minimum deductible and out-of-pocket maximum when preparing for the 2027 plan year.

If you allow employees to make pre-tax contributions to an HSA, you should also update your plan communications to reflect the new amounts.

The many benefits of HSAs

An HSA is a special bank account for your employees’ eligible health care costs. They can contribute to their HSA through pre-tax payroll deductions, deposits or transfers. As the balance grows over time, they can continue to save it or spend it on eligible medical expenses.

Employers can also contribute to the accounts, but the annual contribution limit applies to all employee and employer contributions combined.

The money in the HSA belongs to the employee and is theirs to keep, even if they switch jobs. If their new employer offers qualified HDHPs, they can continue to fund the account.

Funds roll over from year to year and can earn interest. Many plans also have investment options to help savers grow the account further.

There are several benefits for employees who have an HSA:

  • The money an employee contributes to an HSA is not subject to income taxes, which reduces their overall taxable income.
  • They are not taxed on withdrawals.
  • If employees contribute to their HSA with after-tax money, they can deduct their contributions on Form 1040 at tax time.
  • Employees can tap the funds for any approved out-of-pocket medical expenses.
  • They can also grow the account tax-free by investing the funds, like a nest egg for medical expenses in retirement.

HSA-eligible expenses

  • Payments for services or medicine that count toward health plan deductibles, copayments or coinsurance.
  • Dental or vision care, including orthodontics, eye exams and corrective lenses.
  • Medical devices.
  • Certain over-the-counter medicines, such as pain relievers, allergy medication, cold and flu medicine or menstrual products.
  • Vitamins and health supplements, if recommended by a medical or health professional to treat or prevent a specific disease or condition.
"online
Uncategorized

Bill Would Require Health Plans to Count Online Drug Purchases Toward Deductibles

by Inoventive Solutions
May 26, 2026

Workers are increasingly turning to direct-to-consumer online drug platforms like Amazon Pharmacy, Mark Cuban Cost Plus Drug Company and the government-backed TrumpRx to buy prescription medications at prices sometimes far lower than what they would pay through their employer-sponsored health plans. But in many cases, the money they spend on those drugs does not count toward their health plan deductible or annual out-of-pocket maximum.

A new bill in Congress aims to change that. The Every Dollar Counts Act, introduced by Rep. Greg Murphy (R-North Carolina), would require health insurers to apply out-of-pocket spending on covered prescription drugs toward a patient’s deductible and out-of-pocket maximum regardless of where the drugs were purchased. 

Murphy, a physician and longtime critic of insurers and pharmacy benefit managers, said the legislation is designed to remove barriers that discourage patients from using lower-cost prescription drug options.

Direct-to-consumer drug platforms have gained traction by bypassing some traditional distribution channels and offering discounted pricing, particularly for certain brand-name medications. The issue has drawn additional attention following the White House-backed launch of TrumpRx earlier this year, which seeks to negotiate lower drug prices directly with manufacturers. 

Supporters of the legislation argue that the current system can effectively force patients to “pay twice.” Even if a worker saves money by purchasing a medication through a low-cost online platform, those expenditures often do not help satisfy the plan deductible unless the drug is purchased through a plan-approved pharmacy or pharmacy benefit manager network. 

For employers, the proposal highlights a growing tension in prescription drug benefits. On one hand, allowing employees to use lower-cost purchasing options could reduce out-of-pocket expenses and improve medication adherence. Employees who can afford their medications are more likely to stay on treatment and avoid costlier health complications later.

On the other hand, some employers and health plans may worry that the bill could weaken cost-management strategies tied to network pharmacies, formularies and benefit design. Plans often use deductibles, copayments and preferred pharmacy arrangements to steer participants toward negotiated pricing and control overall drug spending.

The debate could shape how workers access lower-cost medications and how health plans balance affordability with efforts to manage overall drug spending.

"Health
Uncategorized

How Health Insurers Are Trying to Rein in Costs Without Cutting Value

by Inoventive Solutions
May 5, 2026

Employers are grappling with another year of steep increases in group health plan premiums due to medical cost inflation, higher utilization and rising drug prices.

At the same time, health insurers can no longer shift additional costs to employers and employees through higher deductibles or narrower networks.

Instead, many insurers are pursuing structural changes designed to control long-term costs while improving care quality and member experience.

Interviews with health plan executives and recent industry reporting point to a common theme: reducing avoidable care, simplifying administration and investing earlier in health to prevent expensive problems later.

Employers and their staff can benefit from these strategies, which are increasingly being built into plan design, provider networks and care management programs that influence both premiums and employees’ out-of-pocket costs.

Preventive and personalized care

A central focus for many insurers is expanding preventive care and making it easier for enrollees to engage with their providers before health issues worsen. Executives at plans such as Humana and Highmark Wholecare, in a recent roundtable with the news website Becker’s Payer Issues, emphasized coordinated care models that connect primary care, specialists and support services around the individual.

These models rely on data and digital tools to identify care gaps early, such as missed screenings or unmanaged chronic conditions. Members may receive targeted reminders, care manager outreach or digital coaching to stay on track. For employers, this approach can translate into:

  • Fewer high-cost claims tied to late-stage disease
  • Fewer avoidable hospitalizations
  • Fewer emergency department visits

Employees benefit from clearer guidance, easier navigation of benefits and more proactive outreach instead of reacting to health issues once they become serious and costly.

Cost containment through innovation and collaboration

Insurers are increasingly rethinking how care is paid for and delivered. Many are expanding value-based payment arrangements that reward providers for keeping patients healthy rather than paying for higher volumes of services.

Under these arrangements, insurers and providers share data and align financial incentives around outcomes and the total cost of care.

Plans are also using predictive analytics and artificial intelligence to identify members at higher risk of complications and intervene earlier through care coordination, remote monitoring or alternative sites of care.

For employers, this can help slow medical cost growth over time without eroding access to care for their employees.

Administrative efficiency and transparency

Health plans are investing in modernized claims systems, real-time eligibility and claim validation and more streamlined prior authorization for routine or evidence-based care.

Some plans are reducing or reforming prior authorization requirements where data shows little value, while using technology to make remaining reviews faster and more predictable. Insurers are also working to improve transparency around costs and benefits, helping members better understand service costs and coverage before care is delivered.

For employers, lower administrative costs can help moderate premium growth and reduce HR workload tied to billing disputes and employee questions. Employees may benefit from fewer delays, clearer explanations of benefits and less confusion when accessing care.

What this means for employers

While no single initiative will eliminate health care cost pressure, insurers argue that combining preventive care, value-based payment and administrative simplification offers a more durable path forward.

Employers evaluating plan options may want to work with us to assess how their carriers are implementing these or similar strategies and how they measure success.

"health"/
Uncategorized

Employers Should Make Employee Health Care Literacy a Top Priority

by Inoventive Solutions
April 7, 2026

For many U.S. workers, health insurance remains confusing, intimidating and underutilized. Despite the billions employers spend on benefits each year, a large share of employees does not fully understand how their coverage works or how to use it effectively.

According to a report by Aflac, only 38% of employees said they understand everything about their benefits, suggesting that most workers need more guidance on how their coverage works. When employees lack health care literacy — the ability to find, understand and use health information and services — they are more likely to delay care, make poor medical decisions and incur unnecessary costs.

For employers, that translates into higher claims costs, lower productivity and frustration with benefit programs.

Improving health care literacy can deliver measurable benefits. The Centers for Disease Control and Prevention has estimated that better health literacy could prevent nearly 1 million hospital visits annually and save more than $25 billion in health care costs.

The cost of confusion

Employees who do not understand their benefits often:

  • Use out-of-network providers unnecessarily.
  • Choose higher-cost care settings, like emergency rooms for non-emergencies.
  • Skip preventive care that could head off more serious conditions later.
  • Misinterpret bills or fail to challenge incorrect charges.

These behaviors drive up employer-sponsored plan costs and can also lead to more absenteeism and presenteeism.

Open enrollment is not enough

Many employers concentrate their communication efforts during open enrollment. While important, that once-a-year push is not enough to build true understanding.

Employees make health care decisions year-round, like when they schedule a test, fill a prescription or choose where to seek care. Without ongoing education, even well-designed benefit plans can go underutilized and employees may make costly choices.

Employers that take a continuous approach to education are more likely to see employees engage with their benefits and make smarter decisions.

Practical ways to build health care literacy

Employers do not need to overhaul their benefits strategy to make progress. Small, consistent steps can have a meaningful impact:

  • Use plain language. Rewrite benefit materials to eliminate jargon and explain key terms like deductibles, copays and coinsurance in simple terms. Aim for a sixth- to eighth-grade reading level.
  • Educate year-round. Provide monthly or quarterly communications that focus on one topic at a time, such as preventive care, telemedicine or how to read an explanation of benefits.
  • Show real-world examples. Compare costs for common scenarios like urgent care vs. emergency room visits so employees see the financial impact of their choices.
  • Promote in-network savings. Use visuals or tools that highlight how much employees can save by staying within network providers.
  • Leverage multiple channels. Combine e-mail newsletters, intranet content, webinars and short videos to meet employees where they are.
  • Offer decision support. Provide access to benefits counselors, either in person or virtually, to help employees choose plans and understand coverage.
  • Encourage preventive care. Regular reminders about screenings, vaccinations and annual checkups can reinforce healthy behaviors and reduce long-term costs.
  • Use data to guide efforts. Review claims trends and employee questions to identify where confusion is highest, then tailor education accordingly.

Build trust and engagement

Employers that invest in health care literacy often become a trusted source of information for their workforce. That trust can increase participation in wellness programs, improve satisfaction with benefits and strengthen retention.

It also aligns with a broader shift in how employees view their benefits. Workers increasingly expect guidance and want help navigating a complex system. Fortunately, employers are well positioned to provide it.

"A
Uncategorized

A Multi-Generational Approach to Employee Benefits

by Inoventive Solutions
March 24, 2026

Open enrollment season can feel like a familiar ritual: publish the guide, send a few e-mails, hold one webinar and hope employees make good choices. But when employers take a one-size-fits-all approach to benefits design and communication, they often leave participation, satisfaction and retention on the table.

The modern workforce spans four generations, each shaped by different life stages, financial pressures and comfort levels with technology. That means the same benefits message and enrollment experience will land differently depending on who is receiving it. Recent surveys have found benefits satisfaction has slipped, suggesting expectations are rising faster than many programs and communications are evolving.

Benefits are complex, personal and often tied to major life decisions. When communications are too generic or the enrollment process feels frustrating, employees may tune out, postpone decisions or default to last year’s elections even when their needs have changed.

The employers that win on engagement typically do three things well:

  • Segment the workforce — Generation, life stage, family status, career stage, location and role
  • Offer multiple ways to learn — Digital, live and self-serve
  • Make the experience easy — Clear choices, fewer clicks and fast answers

Baby boomers

Boomers are often focused on retirement readiness, health care coverage and protecting income. Many are already of retirement age but choose to keep working. They typically appreciate a personal touch and time to digest information before making decisions.

  • Offer live Q&A sessions and phone-based support during enrollment.
  • Provide clear comparisons of medical plan costs, networks and coverage.
  • Highlight catch-up retirement contributions and step-by-step retirement planning resources.
  • Pair complex choices (Medicare coordination, supplemental products and long-term care options) with one-on-one counseling.

Generation X

Gen X employees often juggle competing responsibilities, including kids and aging parents. They tend to value autonomy, straightforward information and tools that respect their time.

  • Use concise e-mails and one-page summaries that link to more details as needed.
  • Offer self-serve decision tools for health plans, FSAs and disability coverage.
  • Emphasize financial protection benefits (life, disability and critical illness) in plain language.
  • Provide flexible office hours for short calls, not long meetings.

Millennials

Millennials commonly look for flexibility and benefits that support evolving family and financial needs. They are comfortable with digital enrollment but still want clarity and proof of value.

  • Build mobile-friendly enrollment processes with short videos and brief explainers.
  • Spotlight flexibility-related benefits such as remote options, caregiving support and paid leave when applicable.
  • Promote financial wellness resources, student loan support or budgeting tools if offered.
  • Tie benefits to career growth, such as tuition support, certification reimbursement, mentorship and internal mobility.

Generation Z

Gen Z is highly responsive to technology-driven experiences and expects speed, transparency and easy access. They also tend to prioritize mental well-being and want information in short, visual formats.

  • Use text message-style reminders, in-app nudges or chat-based help if possible.
  • Provide bite-size content like short videos, FAQs and simple “what it covers” flyers.
  • Make mental health benefits easy to find and use, including EAP access and digital options.
  • Offer guided enrollment portals for those new to employee benefits, including definitions and examples.

Execution

A workable multigenerational strategy does not require building four separate benefits programs. Start by updating how workers access, understand and use existing benefits.

  • Survey and listen: Ask employees what they use, what confuses them and how they prefer to receive information.
  • Offer “digital plus human”: Keep digital enrollment simple but back it up with real-time support for complex questions.
  • Measure what matters: Track participation by benefit type, access methods, call center volume and common questions. Then refine communications year-round.
  • Segment by life stage, not just age: Family status, health needs and financial stress often predict benefit priorities better than age alone.

When employees can engage with benefits in ways that fit them best, enrollment tends to rise, confusion drops and benefits become a more visible driver of satisfaction and retention.

"No
Uncategorized

No Surprises Act Is Failing and Driving Health Plan Costs

by Inoventive Solutions
March 10, 2026

A coalition of more than 60 employer groups, insurers, patient advocacy organizations and labor groups is urging the federal government to crack down on what they say is widespread abuse of the arbitration process created under the No Surprises Act.

In a Feb. 24, 2026 letter to the U.S. Departments of Treasury, Labor and Health and Human Services (HHS), the organizations asked the Trump administration to tighten oversight of the law’s independent dispute resolution system. The groups argue that the process, which was designed to settle payment disputes between insurers and out-of-network medical providers, is being manipulated in ways that increase health care costs.

A study cited in the letter found that the IDR process generated at least $5 billion in wasteful spending between 2022 and 2024, including administrative fees and arbitration awards that far exceed typical market rates.

How the No Surprises Act works

The No Surprises Act took effect in 2022 and was designed to protect patients from unexpected medical bills. Before the law, patients could receive large bills if they unknowingly received care from out-of-network providers (for example, an out-of-network anesthesiologist at an in-network hospital).

The law prohibits providers from billing patients for these unexpected charges. Instead, insurers and providers must negotiate payment for the service. If they cannot reach an agreement within 30 days, either side can initiate the IDR arbitration process.

Congress intended the process to serve as a limited backstop for resolving occasional disputes, but it has evolved into something far larger.

Federal regulators originally estimated that about 17,000 disputes would enter arbitration each year. Instead, more than 3.3 million disputes were filed between mid-2022 and May 2025, according to a study published in Health Affairs.

Act is a new cost driver

The Office of the Assistant Secretary for Planning and Evaluation, a division of HHS, issued a report in 2026 that found the act is driving up costs for health plans, payers and patients. It found that:

  • About 85% of the disputes that flowed through the system in 2023 involved participants in health plans sponsored by private employers.
  • IDR reviewers took an average of 91 days to handle disputes, and some took more than 300 days to close some disputes.
  • The reviews cost an average of $445 each.
  • The reviewers sided with providers in hospital care cases 80% of the time.
  • When reviewers sided with the providers, they awarded significantly higher payment rates. For example: For colonoscopy anesthesia, health insurers paid providers an average of $300 in 2023. When an IDR reviewer handled a dispute involving the procedure, it awarded an average payment of $1,252.

What the coalition wants

Industry analysts say the growing use of arbitration is already creating new affordability pressures for employer health plans and their employees through higher premiums, deductibles and cost-sharing.

In their letter, the groups urged federal regulators to take several steps to restore the arbitration system to its intended purpose.

They recommended that the agencies:

  • Strengthen enforcement to ensure only eligible claims enter the IDR process.
  • Require arbitrators to explain decisions that deviate significantly from benchmark payment levels.
  • Increase transparency around arbitration outcomes.
  • Penalize providers that repeatedly submit ineligible claims.

The coalition argues that stronger oversight is necessary to ensure the No Surprises Act continues protecting patients without unintentionally driving up health care costs for employers and their workers.

"Umbrella
Uncategorized

Are Your Benefits Enough to See Employees Through a Crisis?

by Inoventive Solutions
March 3, 2026

Middle-class families — those with incomes of between roughly $50,000 and $180,000 per year (depending on where they live) — are becoming increasingly reliant on workplace benefits to ensure their financial well-being in case of a disability or critical illness.

Simple health insurance is insufficient to carry the load. The loss of a breadwinner’s or caregiver’s financial contribution through death or disability is often devastating.

A recent survey by benefits provider Guardian indicates that families in this category are struggling when it comes to achieving their financial goals. Of those workers surveyed only half believe they would be able to manage if the household lost an income due to death or illness.

Caught in the middle

Families with incomes significantly above $100,000 per year are generally able to create at least some financial cushion against the possibility of death or disability. They also receive a good deal of advice from financial advisors, accountants and insurance agents in managing their financial affairs. 

Working class families – those with incomes below about $50,000 – are often able to access various parts of the social safety net in times of crisis.

The “middle market,” in contrast, must make do without the advantages of the more affluent, with fewer privately owned insurance products and services, and without the same access to the social safety net afforded to working-class families.

Workplace benefits are critical 

According to Guardian’s researchers, the middle-market population is overwhelmingly reliant on the quality and breadth of the benefits they receive at work, over and above cash compensation.

Over 80% of middle-market respondents report that they got their health insurance, disability insurance and retirement plan all through their employer.

Meanwhile, six in 10 have no life insurance in place outside of the workplace. This means that the solid majority of working families are relying entirely on workplace benefits to see them through the death of a family breadwinner.

And in the event of disability ending a breadwinner’s income, the situation is even more dire: Only 7% of the middle market owns any kind of disability insurance protection, outside of what they can access via their employer.

Are life insurance benefits adequate? 

For young families, the primary role of life insurance is to replace the income of a deceased breadwinner. But many employers cap life insurance benefits at $50,000 — the maximum figure that allows employers to deduct premiums as a workplace benefit under IRC 7702.

The actual need for many of these families is several hundred thousand to a million dollars, and occasionally more. That’s what it takes to replace the income of a worker who earns $50,000 to $100,000 per year until the children are out of college and a surviving spouse is taken care of.

The cap on group life insurance is often not enough to help a family who loses their breadwinner, and the coverage should be considered a stopgap for a more robust life insurance policy purchased in the private market. 

What employers can do

One solution is to offer voluntary benefits to workers. These include a menu of benefits, such as:

  • Group life insurance
  • Group disability insurance
  • Long-term care insurance
  • Critical illness coverage

Often, many of these benefits can be offered at little or no cost to the employer. 

Premium costs are simply deducted from the worker’s wages and forwarded to the insurance company via payroll deduction. In this way, workers can purchase much more coverage and provide protection for their families – and it doesn’t cost the employer a dime.

In some instances, it can even save on payroll taxes.

To learn more, call us. 

"holding
Uncategorized

More Employers Offer Caregiver Leave as Need Mounts

by Inoventive Solutions
February 24, 2026

A new survey found that many employers plan to add or expand caregiver leave as they contend with workforce burnout, changing family dynamics and competition for talent.

According to WTW’s “2025 Absence, Disability and Medical Leave Survey,” caregiver leave is expected to see the fastest growth of any leave benefit over the next two years, despite only a handful of states requiring it by law. The shift comes as caregiving demands intensify across a multigenerational workforce. Many employees juggle work while caring for aging parents, children or other dependents, often with limited financial or workplace support.

Employers are finding that caregiver leave can help reduce stress and burnout, improve morale and productivity and support retention in a tight labor market where replacing workers is increasingly expensive.

What the WTW survey found

  • 73% of employers plan to enhance leave programs over the next two years.
  • 39% of employers expect to offer caregiver leave within two years, up from 22%.
  • Employers cite improving employee experience (67%) and strengthening attraction and retention (60%) as the top reasons for expanding leave benefits.
  • 49% of employers identify leave program administration as their biggest challenge, followed by system integration and workforce coverage.

The importance of caregiver leave

Caregiver leave addresses a growing gap for a workforce that increasingly spans multiple generations. Nearly one quarter of U.S. adults are part of the so-called “sandwich generation,” caring for both children and aging parents, according to another report. These employees often provide about 20 hours of unpaid care per week and may spend $10,000 to $11,300 a year out of pocket to support family members.

Although caregiver leave may qualify under the Family and Medical Leave Act (FMLA), it is typically unpaid unless employers offer wage replacement. That financial strain can increase stress and burnout, pushing some caregivers to reduce their hours, change jobs or leave the workforce entirely.

From a business standpoint, caregiver leave can help mitigate turnover risk. Replacing an employee can cost about 30% of annual pay. While caregiver leave will not eliminate turnover, it can lower the risk that employees leave because of caregiving responsibilities.

How employers can implement caregiver leave

Employers considering caregiver leave often start by integrating it into their existing leave or paid time off structures.

Common approaches include offering a defined number of paid leave days per year, allowing caregiving use of banked personal time off or layering caregiver leave on top of state paid family leave programs.

Best practices include:

  • Defining caregiving broadly to cover children, parents, spouses, domestic partners and other dependents.
  • Coordinating caregiver leave with FMLA and state programs to avoid duplication and ensure compliance.
  • Setting clear eligibility and documentation standards while keeping the process simple for employees.
  • Training managers to handle workload planning and employee conversations.

Overcoming administrative and operational challenges

Administration remains one of the biggest barriers to expanding caregiver leave. Challenges include coordinating multiple leave programs, maintaining multistate compliance and managing staffing as leave usage increases.

To address these issues, many employers are:

  • Outsourcing leave administration to specialized vendors.
  • Standardizing policies and systems across locations.
  • Using technology to support routine leave management.
  • Monitoring utilization to ensure caregiver leave is accessible and free of stigma.

The takeaway

As caregiving responsibilities continue to affect a growing share of the workforce, caregiver leave is emerging as a practical, targeted benefit that supports employees while helping employers attract and retain talent in a competitive labor market.

"Shot
Uncategorized

Voluntary Benefits Lawsuits Add Fiduciary Concerns for Employers

by Inoventive Solutions
February 3, 2026

Plaintiff’s lawyers are breaking new ground by suing employers for allegedly failing in their fiduciary duties to manage their voluntary benefit plans, including dental, vision, accident insurance, critical illness, cancer and hospital indemnity benefits.

These class action lawsuits typically allege that employers exercise sufficient control over these plans to trigger fiduciary duties under the Employee Retirement Income Security Act (ERISA) and that those duties were breached. Once ERISA applies, employers can face claims tied not just to plan design, but to the prudence of benefit selection and monitoring.

If these lawsuits gain traction, they may open a new category of potential liability tied to benefit offerings that many employers have historically overlooked.

At the center of the litigation is the claim that certain voluntary benefit arrangements are not exempt from ERISA, either because they fail to meet the voluntary plan safe harbor or because employers exercise sufficient control to trigger fiduciary duties.

Five areas drawing scrutiny

Four recent class action lawsuits filed against large employers include similar allegations that the employers and their benefits brokers breached ERISA fiduciary duties by allowing excessive commissions, failing to monitor insurers and brokers and engaging in conflicted arrangements within employer-sponsored voluntary benefits programs.

Each of these companies was sued by an employees’ union benefit or welfare plan:

  • United Airlines
  • Laboratory Corporation of America
  • Community Health Systems
  • Allied Universal

Key areas of alleged exposure include:

1. Benefits selection processes — Employers are being accused of failing to run competitive requests for proposals, benchmark offerings or document why certain carriers or products were chosen. A casual selection process that keeps the same plan each year can be portrayed as imprudent once fiduciary standards apply.

2.  Contracts — Agreements with insurers, brokers and enrollment vendors are under the microscope. Vague terms, unclear delegation of responsibilities or contracts that fail to spell out fiduciary status can make it harder for employers to defend their role as plan sponsors.

3. Broker and vendor compensation provisions — Embedded commissions, overrides and incentive payments are a central theme in the lawsuits. Plaintiffs argue that employers failed to monitor compensation levels or allowed conflicted arrangements that inflated employee premiums.

4. Premium levels — Even when employees pay the full cost, plaintiffs contend that employers must ensure premiums are reasonable relative to the benefits provided. A lack of benchmarking can be framed as a breach of the duty of prudence.

5. Insurance product loss ratios — Loss ratios are being used as a proxy for value. Low ratios may be cited as evidence that plans were overpriced or structured to favor intermediaries rather than participants.

Steps employers can take

While none of these cases has been decided on the merits, they send the message that voluntary benefits are no longer viewed as litigation-proof. Employers and HR leaders may want to consider:

  • Confirming whether each voluntary benefit arrangement is intended to be ERISA-covered or exempt — and documenting that determination.
  • Reviewing contracts to clarify fiduciary roles, responsibilities and delegation.
  • Increasing transparency around broker and vendor compensation, including commissions and incentives.
  • Benchmarking premiums and insurer loss ratios against the broader market.
  • Documenting benefit selection decisions and the rationale behind them.
  • Strengthening employee decision support and education to demonstrate a focus on participant outcomes.

Voluntary benefits may remain optional for employees, but the lawsuits suggest fiduciary oversight is becoming less optional for employers. Employers that pay closer attention now to ensure compliance with any applicable fiduciary duties can reduce their risk of becoming the next test case.

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