Akerman Executive Committee Member and Employee Benefits and Executive Compensation Partner Beth Alcalde and Employee Benefits and Executive Compensation Associate Chase Nevitt contributed “Key Legal Considerations for Employer Health Plan Sponsors” to HR.com’s Employee Benefits & Wellness Excellence, outlining the increasingly complex regulatory and compliance landscape facing employer-sponsored health plans.
In the article, Beth and Chase explain how persistent access gaps, rising costs, and expanding transparency requirements are converging into a more demanding compliance environment for plan sponsors. They highlight growing regulatory pressure across areas such as mental health parity, data transparency, and pharmacy benefit management, underscoring the need for employers to address these issues as interconnected risks rather than in isolation.
Beth and Chase outline key considerations for plan sponsors, including network adequacy and compliance with mental health parity requirements, telehealth and direct primary care arrangements, and the legal and administrative complexities associated with alternative coverage models such as individual coverage health reimbursement arrangements. They also address rising healthcare costs driven by specialty pharmaceuticals and increased utilization, as well as the expanding impact of pharmacy benefit manager regulation.
Beth and Chase further address federal transparency requirements and challenges of coordinating multiple vendors, emphasizing the importance of strong contractual protections, data access, and fiduciary oversight. They conclude that plan sponsors should take a proactive, integrated approach to compliance by strengthening governance, enhancing vendor oversight, and aligning plan design with evolving regulatory expectations, consistent with best practices.