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IRS announces increased ACA employer shared responsibility penalties for 2027. Posted by BAS - 04 June, 2026 The IRS has released updated Affordable Care Act ("ACA") employer shared responsibility penalty amounts for the 2027 calendar year. The new indexed amounts reflect another increase in potential penalties for applicable large employers ("ALEs") that fail to comply with ACA employer mandate requirements. Under the ACA, ALEs, generally employers with 50 or more full-time and full-time equivalent employees, may face penalties if they do not offer qualifying health coverage to eligible full-time employees and their dependents. For 2027, the IRS adjusted the penalties as follows: * The Code § 4980H(a) penalty, often referred to as the "A penalty," will increase to $3,780 per full-time employee, after excluding the first 30 employees. This penalty may apply if an ALE fails to offer minimum essential coverage to at least 95% of its full-time employees and their dependent children, and at least one employee receives subsidized coverage through a Health Insurance Marketplace. * The Code § 4980H(b) penalty, often referred to as the "B penalty," will increase to $5,670 per full-time employee who receives subsidized Exchange coverage because the employer's offered coverage was either not affordable or did not provide minimum value. These updated amounts represent significant increases from the 2026 penalty levels and highlight the continuing financial exposure associated with ACA compliance failures. HR and benefits teams should use this as a reminder to review ACA compliance procedures regularly, including: * Proper identification of full-time employees * Measurement and tracking of employee hours * Timely offers of coverage * Affordability testing under ACA safe harbors * Verification that plan options continue to meet minimum value requirements * Accurate ACA reporting and documentation practices With penalties continuing to rise, maintaining consistent ACA administration and documentation processes remains an important part of reducing compliance risk for employers. For information about BAS' ACA data collection and compliance services, contact your account manager or [email protected]. Benefit Allocation Systems (BAS) provides best-in-class, online solutions for: Employee Benefits Enrollment; COBRA; Flexible Spending Accounts (FSAs); Health Reimbursement Accounts (HRAs); Leave of Absence Premium Billing (LOA); Affordable Care Act Record Keeping, Compliance & IRS Reporting (ACA); Group Insurance Premium Billing; Property & Casualty Premium Billing; and Payroll Integration. MyEnroll360 can Integrate with any insurance carrier for enrollment eligibility management (e.g., Blue Cross, Blue Shield, Aetna, United Health Care, Kaiser, CIGNA and many others), and integrate with any payroll system for enrollment deduction management (e.g., Workday, ADP, Paylocity, PayCor, UKG, and many others). This article is for informational purposes only and is not intended as legal, tax, or benefits advice. Readers should not rely on this information for taking (or not taking) any action relating to employment, compliance, or benefits. Always consult with a qualified professional before making decisions based on this content. About BAS' Newsletter Join its free, weekly blog email list to be the first to learn about the hottest HR Issues, MyEnroll360 Features, Systems Security, and Weekly Topics of Interest. "The News to Use that BAS/CCS sends every Thursday always has great info, but particularly the Question of the Week is a great resource!" Account Manager / Employee Benefits PA Insurance Broker

Texas Federal Court dismisses Blue Cross Blue Shield of Texas lawsuit against halomd with prejudice. PR Newswire Today at 10:05pm PDT PR Newswire DALLAS, May 27, 2026 The Eastern District of Texas is The Fourth Federal Court in Six Weeks to Reject Insurer Attempts to Relitigate IDR Awards Under the No Surprises Act DALLAS, May 27, 2026 /PRNewswire/ - HaloMD today secured a decisive victory in the U.S. District Court for the Eastern District of Texas after Judge Robert W. Schroeder III dismissed with prejudice all seven claims brought by Blue Cross Blue Shield of Texas (BCBS Texas), a division of Chicago-based Health Care Service Corporation (HCSC), against HaloMD and the other defendants. In an 18-page ruling, the Court rejected BCBS Texas's attempt to use a combination of federal and state law theories to undermine the No Surprises Act (NSA) and the binding nature of awards issued under Independent Dispute Resolution (IDR). In response to BCBS Texas's attempted end-run around the arbitration process, the Court found that, "...the collateral attack doctrine is even more clearly applicable where, as here, Plaintiff is attempting to relitigate issues previously decided by the IDR entities...". The same analysis applied to claims arising under the Texas IDR process established by Senate Bill 1264. "The court got this case exactly right," said Justin Carangelo, General Counsel and Chief Compliance Officer of HaloMD. "The NSA forecloses judicial review of IDR awards. This is the fourth federal court to reject attempts to weaken the NSA in the last six weeks. Insurers engaged in similarly wasteful litigation should assess whether continuing to do so is an intelligent use of resources." "Left unresolved by today's decision, in HaloMD's view, is the growing backlog of past-due payments under the No Surprises Act that BCBS Texas and parent company HCSC owe to healthcare providers for care already provided to patients," said Patrick Velliky, Chief External Affairs Officer of HaloMD. "HaloMD maintains HCSC has failed to pay tens-of-millions-of-dollars in legally binding awards." A Pattern of Rulings Defending the IDR Framework Today's dismissal follows similar rulings in litigation against HaloMD, as well as other unrelated parties, across federal courts, including the dismissal of an almost identical suit in the Central District of California, a parallel ruling in the Middle District of Florida, and an additional dismissal in the Eastern District of Pennsylvania. Since taking effect on January 1, 2022, the No Surprises Act has protected millions of Americans from surprise medical bills. The law established the IDR process as the binding mechanism for resolving payment disputes between out-of-network providers and insurers, while holding patients harmless from financial exposure beyond their in-network responsibility. Texas Senate Bill 1264, enacted in 2019, established a state IDR process with its own limits on judicial review. In both frameworks, IDR determinations, once made, are final and binding by design. The case is Blue Cross Blue Shield of Texas v. HaloMD, LLC et al., Case No. 5:25-CV-132-RWS (E.D. Tex.). About HaloMD HaloMD is the #1 provider of Independent Dispute Resolution (IDR) services as indicated by public CMS data, backed by industry leading technology infrastructure and data intelligence. The company supports healthcare providers navigating the federal No Surprises Act and state balance-billing laws, combining proprietary technology, advanced analytics, and deep specialty expertise to advance fair reimbursement, long-term financial sustainability, and empowering care teams to focus on providing high quality patient care. Privately held and founder-led, HaloMD serves more than 20,000 providers, from independent physicians to hospitals and health systems, across 50 states and Washington, D.C., so they can continue caring for the patients and communities they serve. SOURCE HaloMD This is a paid placement. For further inquiries, please contact PR Newswire directly.

Blue Cross antitrust payments: what policyholders should know. Blue Cross antitrust settlement payments: what policyholders should know. Antitrust settlements involving major health insurers like Blue Cross Blue Shield have reached a critical phase for policyholders. After years of legal battles, affected members are now positioned to receive payments as part of a historic settlement agreement. These payments stem from allegations that Blue Cross Blue Shield and its affiliated companies engaged in anticompetitive practices that artificially inflated premiums and restricted market competition across multiple states. The settlement, which totals over $2.67 billion, was finalized in 2022 and covers a period stretching back to 2008. It represents one of the largest antitrust resolutions in U.S. healthcare history. While the legal process has concluded, the distribution of funds to eligible policyholders remains a point of focus. Understanding eligibility, timelines, and the broader implications of this case is essential for millions of Americans who were covered under Blue Cross plans during the affected years. How the settlement came to be. The origins of this antitrust case trace back to 2012, when a group of plaintiffs filed a class-action lawsuit against the Blue Cross Blue Shield Association and 34 of its independently operated licensees. The core accusation was that the insurer maintained a market allocation scheme through its licensing agreements, which effectively divided the country into exclusive territories. This structure, according to the plaintiffs, prevented competition and allowed Blue Cross to dominate regional markets without meaningful challenge. After nearly a decade of litigation, including multiple appeals and a pivotal 2020 ruling by the U.S. Supreme Court, both sides reached a settlement agreement. The deal was approved by a federal judge in 2022, paving the way for compensation to affected policyholders. The settlement also required Blue Cross to modify certain business practices to comply with antitrust laws going forward. It's worth noting that while Blue Cross did not admit to wrongdoing, the agreement reflects a strategic resolution to avoid prolonged legal uncertainty. For policyholders, the immediate benefit comes in the form of potential payments - though the amount varies depending on individual circumstances. Who is eligible for a payment? Eligibility for a share of the settlement is determined by specific criteria outlined in the court-approved notice. Individuals who meet the following conditions may qualify: * Held a fully insured health insurance policy issued by a Blue Cross Blue Shield company between February 16, 2008, and October 16, 2020. * Were not covered under a self-insured or employer-sponsored plan administered by Blue Cross. * Resided in one of the 35 states and the District of Columbia where the lawsuit applied. * Can provide proof of coverage during the relevant time period, such as an insurance card or policy statement. The settlement administrator, Epiq Class Action & Mass Tort, has emphasized that policyholders do not need to submit a claim to receive a payment. Eligible individuals were automatically identified based on insurance records, and payments were issued directly to those on file. However, individuals who believe they qualify but did not receive a payment are encouraged to contact the settlement administrator to verify their status. It's important to remain cautious of potential scams. Official communications about the settlement are sent through postal mail and email from verified addresses. Blue Cross and its affiliates will never ask policyholders to pay a fee or provide sensitive information to receive a settlement check. How much could policyholders receive? One of the most common questions surrounding this settlement is: "How much will I get?" While the exact amount varies, the average estimated payment per eligible policyholder is approximately $43. This figure was derived from the total settlement fund of $2.67 billion, divided across an estimated 63 million class members - a number that reflects the broad scope of affected individuals. It's important to clarify that these payments do not represent full reimbursement for premiums paid during the affected years. Instead, they serve as a form of restitution acknowledging the anticompetitive conduct that occurred within the Blue Cross system. Payments are issued as one-time checks or electronic transfers, with no requirement to use the funds for medical expenses. For those seeking a clearer picture, the settlement website provides a payment calculator that allows users to input their policy details and receive an estimated range. While the actual amount may differ slightly due to administrative adjustments, this tool offers a helpful reference point. Tax implications of settlement payments. Like most legal settlements involving financial compensation, these payments may be subject to federal and state income taxes. According to IRS guidelines, antitrust settlement proceeds are generally considered taxable income unless specifically exempted by law. Policyholders who receive payments should plan accordingly and consult a tax professional to understand their obligations. The settlement administrator is required to issue Form 1099-G to all recipients, detailing the gross amount of the payment. This form should be retained for tax filing purposes. While some states may also tax this income, others - such as California - have historically provided exemptions for certain class-action settlements. Taxpayers are advised to review state-specific rules to avoid surprises during filing season. What this means for the future of health insurance. Beyond the immediate financial impact, this settlement carries significant implications for the health insurance industry. The case underscored the scrutiny that major insurers face regarding market consolidation and pricing transparency. It also highlighted the role of class-action lawsuits in holding corporations accountable for alleged anticompetitive behavior. In response to the settlement terms, Blue Cross Blue Shield announced internal reforms aimed at increasing competition and improving consumer choice. These changes include modifications to licensing agreements and enhanced disclosures about plan pricing and coverage options. While critics argue these measures do not go far enough, they represent a step toward greater regulatory compliance. For consumers, the settlement serves as a reminder to stay informed about the companies behind their health coverage. Understanding the structure of an insurer's business - including whether it operates under a national alliance with regional affiliates - can provide insight into potential market dynamics. Policyholders are encouraged to compare plans annually during open enrollment periods and consider factors beyond premiums, such as network size and customer service ratings. This case also raises broader questions about the concentration of power within the healthcare system. With a handful of insurers controlling a significant share of the market, antitrust enforcement remains a critical tool for promoting competition and protecting consumers. Future legal challenges may emerge as regulators and advocacy groups continue to monitor industry practices. Next steps for affected policyholders. For those who believe they may be eligible but have not yet received a payment, the first step is to verify participation. The settlement website offers a search tool where individuals can input their name and policy number to confirm eligibility. If records indicate coverage during the relevant period, a payment should have been issued automatically. In cases where a check was lost, returned, or never received, policyholders can submit a claim through the settlement portal. Supporting documentation, such as an old insurance bill or policy declaration page, may be required to process the request. The deadline for submitting inquiries has been extended multiple times, with the most recent cutoff set for 180 days after the final payment distribution date. For additional support, the settlement hotline and email channels remain active. Trained representatives can assist with inquiries about payment status, tax implications, and general questions about the case. It's advisable to keep any correspondence related to the settlement in a secure location for future reference. As the healthcare landscape continues to evolve, this settlement stands as a landmark moment in consumer protection. For millions of Blue Cross policyholders, the payments represent a tangible acknowledgment of past practices while offering a chance to reclaim a small portion of what may have been overpaid premiums. Though the amounts may seem modest, their significance lies in the message they send: that market accountability matters, and that even the largest corporations are not above the law. For ongoing updates and official information, visit the News section of Dave's Locker, where Daveslocker continue to track developments in health insurance, antitrust enforcement, and consumer rights.