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.

The 1944 Public Health Service Act covers publicly sponsored health plans by public entities and the federal government. ERISA vs PHSA Health Plan Compliance ERISA vs PHSA health plan compliance is one of the most common—and most misunderstood—regulatory challenges facing today’s employer-sponsored health plans. Whether you manage benefits for a private employer with a large workforce or a public entity such as a university serving thousands of students and staff, federal re

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.

The next “401(k) fee crisis” won’t be about retirement plans — it’s happening in healthcare. Self-funded plan sponsors face a wave of hidden costs buried in ASO, PBM, and stop-loss contracts. What appears to be routine administration often masks charges that drain plan assets and compromise compliance.

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 & 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. Audits offer a snapshot of a carrier’s operations. Reviews are your fiduciary duty under ERISA. Fiduciaries must understand the difference to protect 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.

Excited to see Employee Benefit News highlighting Stephen Carrabba , ClaimInformatics, Inc. , and Jamie Greenleaf, AIF, CBFA, C(k)P,...

At ClaimInformatics, our FOCUS™ platform (Fiduciary Oversight, Compliance, and Utilization Safeguard)—powered by PAIR™ technology, Ongoing Monitoring, Pre-Pay Payment integrity and Recovery Services, and advanced analytics helps plan fiduciaries safeguard participant assets, enforce SPD protections, and achieve compliance with ERISA and the Consolidated Appropriations Act (CAA).

We’re proud to see PLANSPONSOR continuing to advance the fiduciary conversation for employer health plans. In a recent article, Fiduciary...

Without transparency and access to THEIR data, plan sponsors risk breaching fiduciary duty under ERISA and the CAA. The 2025 Pulse of the...

The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established...

The Employee Retirement Income Security Act (ERISA) protects your plan's assets by requiring that those persons or entities who exercise...

Starting in 2022, an estimated 2.5 million employer-sponsors of health plans are required to adopt new fee and pricing transparencies due...