The next “401(k) fee crisis” will not be about retirement plans. It is happening in healthcare. Courts are applying the fiduciary standards from 401(k) fee litigation to self-funded health plans, where hidden costs are buried in ASO, PBM, and Stop-Loss contracts. Learn where these fees hide and how to protect your plan.

CAA 2026, the DOL's enforcement overhaul, and Schlichter's expanding litigation campaign have shifted the ground beneath every self-funded health plan fiduciary. Here is what to do now.

The era of passive plan oversight is over. Schlichter's 4-suit December 2025 dump, the Supreme Court's Cunningham decision, the Sixth Circuit's Tiara Yachts ruling, and the CAA 2026 PBM reforms together create a perfect storm of fiduciary risk. Here's what every self-funded plan fiduciary must know.

Every year, self-funded health plan fiduciaries are handed a legal contradiction. ERISA holds them personally liable for billions in plan assets. Yet the TPAs who actually pay those claims routinely deny access to the data required to validate that spending. A fiduciary cannot prudently oversee what it cannot see.

The January 2026 issue of The Self-Insurer makes one thing clear: 'fiduciary' is no longer a formality buried in plan documents — it's a market force reshaping vendor relationships, compressing margins, and raising expectations for transparency and performance.

That's not a scare tactic. That's the reality of ERISA fiduciary liability for self-funded health plan sponsors, and it's exactly what Stephen Carrabba laid out at a recent industry event.

Courts have made it clear that fiduciaries cannot outsource their responsibility. If your TPA mismanages claims, hides fees, or engages in conflicted practices, liability ultimately rests with you. That's why sponsors must hold TPAs accountable and document oversight.

ERISA vs PHSA health plan compliance is one of the most common, and most misunderstood, regulatory challenges facing employer-sponsored health plans. This guide breaks down the key differences in coverage, fiduciary duties, and compliance obligations for private employers and public entities.

Benefits committees are becoming essential to ERISA compliance for self-funded health plans. Learn why structured oversight of vendors, fees, claims accuracy, and data transparency is a fiduciary imperative, and how benefits committees strengthen governance, reduce risk, and protect plan participants.

Major networks are finally shifting on data sharing. The excuses are gone. It is the employer’s fiduciary responsibility to demand access. If a carrier or vendor refuses, and the pattern continues, you must replace them because their obstruction causes you to breach your fiduciary obligations.

At ClaimInformatics, we help plan sponsors identify hidden fiduciary risks. Before your renewal, we are offering a complimentary ASO Agreement and SPD Analysis, valued at $5,000, to the first 15 self-funded entities who schedule a call this month.

The carrier controls claim audits. Claim reviews are fiduciary responsibilities under ERISA. Understand why reviews are crucial for safeguarding plan assets.

As renewal season unfolds, fiduciaries face a critical opportunity to align contracts with their ERISA duty: act solely in the interest of participants and prudently manage plan assets

Today, self-funded health plans are entering that same era of scrutiny. Just as 401(k) plan sponsors had to adapt to fiduciary standards, employers offering self-funded healthcare must now comply with ERISA and new mandates under the Consolidated Appropriations Act (CAA 2021). Those who fail to evolve risk legal action, regulatory enforcement, and financial harm to both the plan and its participants.

At ClaimInformatics, ClaimIntelligence™ delivers payment integrity across Pre-Pay and Post-Pay, with PAIR™ for historical lookback and Ongoing Monitoring of new claims, while FOCUS™ provides the fiduciary oversight layer, including CLEAR™ contract review, to help plan fiduciaries safeguard participant assets, enforce SPD protections, and achieve ERISA and CAA compliance.

We’re proud to see PLANSPONSOR continuing to advance the fiduciary conversation for employer health plans. In a recent article, Fiduciary In A Box and Claiminformatics collaborated to help employers and their partners streamline fiduciary oversight and document compliance with the Consolidated Appropriations Act (CAA) of 2021. Fiduciary oversight is critical to ensure compliance with CAA ClaimInformatics, Inc. is honored to be recognized as a trusted partner in this effort. O

Without transparency and access to THEIR data, plan sponsors risk breaching fiduciary duty under ERISA and the CAA. The 2025 Pulse of the Purchaser Survey confirms what many of us already know: affordability threats are not easing. For the fifth straight year, employers rank drug prices, hospital costs, and high-cost claims as the top drivers of unsustainable healthcare spending For self-funded plans, these challenges bring heightened fiduciary obligations. According to the

The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry, protecting individuals in these plans. ERISA requires plans to provide participants with plan information, including important information about plan features and funding; provides fiduciary responsibilities for those who manage and control plan assets; requires plans to establish a grievance

The Employee Retirement Income Security Act (ERISA) protects your plan's assets by requiring that those persons or entities who exercise discretionary control or authority over plan management or plan assets, have discretionary authority or responsibility for the administration of a plan, or provide investment advice to a plan for compensation, or have any authority or responsibility to do so, are subject to fiduciary responsibilities. Plan fiduciaries include, for example, p

Starting in 2022, an estimated 2.5 million employer-sponsors of health plans are required to adopt new fee and pricing transparency requirements due to amendments to ERISA. While ERISA has focused on retirement service fees in the past, the spotlight is now on healthcare costs. The requirements fall under the Affordable Care Act (ACA) and Consolidated Appropriations Act, 2021 (CAA 2021), and affect organizations covered by the Employment Retirement Income Security Act of 1974