NFP's Insights from the Experts
by NFP's Insights from the Experts
NFP introduces the Insights from the Experts podcast series. Each episode will showcase timely perspective from members of the NFP community, delivering information, analysis and solutions that address our clients’ most significant challenges.You can find archived episodes of Innovation Conversations at https://soundcloud.com/user-939810789.
Episodes
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Episode 176: New DOL FAQs on Full Rewards, Disclosures on Wellness Programs
In this episode, Chase Cannon and Suzanne Spradley explain how health-contingent wellness programs work under HIPAA. The two outline new DOL FAQs that state that the DOL won't take enforcement action against plans that apply a wellness program reward only prospectively from the alternative…
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EP 175: Value-Based Pricing Models: Group Health Plan Considerations
In this episode, Suzanne Spradley and Chase Cannon explore the growing interest in value-based pricing models for health plans, including bundled payments, capitation, and outcome-based arrangements. The two discuss how these models aim to connect payment with quality and cost outcomes, while...
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EP 174: Compliance Considerations with Value-Based Care Arrangements
In this episode, Suzanne Spradley and Chase Cannon discuss the rise of value-based care (VBC) arrangements and break down the compliance considerations employers should consider when implementing them. Suzanne begins with a description of ERISA’s fiduciary obligations as they relate to VBC...
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EP 173: DOL Proposes New Safe Harbor for Electronic Delivery of Notices
In this episode, Chase Cannon and Suzanne Spradley discuss the Department of Labor’s proposed new electronic disclosure safe harbor for ERISA group health plans. Chase begins with some background on the current DOL electronic disclosure rules. Then, the two discuss how the proposal could…
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EP 172: AI and ERISA Fiduciary Obligations
In this episode, Suzanne Spradley and Chase Cannon discuss the usage of artificial intelligence (AI) in plan-related administrative tasks. Suzanne begins with an outline of how carriers, vendors, TPAs, and employers as plan sponsors are currently using AI. Suzanne and Chase discuss the impact AI...
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EP 171: Recent HIPAA Settlement Aimed at Group Health Plans
In this episode, Chase Cannon and Suzanne Spradley discuss a recent HHS Office for Civil Rights settlement showing that self-insured employer-sponsored group health plans are not outside the reach of HIPAA enforcement — especially when ransomware, electronic PHI, and incomplete risk analysis are...
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EP 170: Revisiting the Tax Exclusion for Employer-Sponsored Insurance Coverage
In this episode, Suzanne Spradley and Chase Cannon revisit the history and importance of the tax exclusion for employer-sponsored insurance (ESI) coverage. Suzanne takes us back to the 1940s to understand how the tax exclusion began. The two discuss the reasons for the longevity and stability of...
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EP 169: Common Compliance Blind Spots for Employer Plan Sponsors
In this episode, Chase Cannon and Suzanne Spradley look at some common blind spots that employers, as plan sponsors, should review with respect to compliance. Chase outlines the first two blind spots that relate to the application of COBRA and COBRA initial notice distribution. Chase and Suzanne...
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EP 168: Two Recent Court Decisions’ Impact on Group Health Plans
In this episode, Suzanne Spradley and Chase Cannon discuss two recent circuit court decisions and their impact on employer-sponsored group health plans. Suzanne first discusses a Sixth Circuit decision involving a state law that attempts to regulate PBMs. Suzanne and Chase walk through Supreme...
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EP 167: Three Upcoming Compliance Deadlines to Consider
In this episode, Chase Cannon and Suzanne Spradley review three important upcoming compliance-related deadlines. Chase highlights the three requirements, including ACA reporting, an April 15 deadline related to HSA contributions and distributions, and RxDC reporting. Chase and Suzanne discuss…
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EP 166: Washington Health Policy Outlook
In this episode, Suzanne Spradley and Chase Cannon review the outlook of health policy in the current Washington, DC environment. Suzanne leads off, setting the stage with a description of the narrow House Republican majority and its impact on enacting legislation. Suzanne and Chase discuss…
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EP 165: 2026 DOL Enforcement Priorities for Group Health Plans
In this episode, Chase Cannon and Suzanne Spradley review a recent DOL announcement that outlines the agency’s enforcement priorities for group health plans. Chase provides some background on DOL enforcement and the DOL’s efforts to increase employee benefit plan compliance, address abusive...
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EP 164: Recent Litigation Highlights ERISA’s Voluntary Benefit Exception and Fiduciary Awareness
In this episode, Chase Cannon and Suzanne Spradley discuss a recent wave of litigation centered on ERISA’s fiduciary obligations for health and welfare plan sponsors. Suzanne begins with an explanation of the lawsuits and how the voluntary benefit plan exception from ERISA is core to the lawsuit...
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EP 163: Recent Guidance on Fertility Benefits Is Out, but Questions Remain
In this episode, Chase Cannon and Suzanne Spradley discuss recently released guidance on fertility benefits. Chase provides the background on how employers might be able to offer fertility benefits as “excepted” or “independent, non-coordinated" benefits, which may ease some compliance burdens....
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EP 162: Noteworthy Guidance from a Shutdown Government
In this episode, Chase Cannon and Suzanne Spradley discuss recent and noteworthy guidance from the IRS despite the federal government shutdown. Chase and Suzanne dive into the recently announced IRS inflation-adjusted amounts for benefits-related items in 2026 and their impact on employer plans....
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EP 161: U.S. Tariffs and Impact on Pharmaceutical Products
In this episode, Suzanne Spradley and Chase Cannon discuss a September 2025 presidential announcement regarding tariffs on pharmaceutical products. Suzanne provides some background on the announcement and what it might mean for the U.S. and other countries. Suzanne and Chase explore the potential...
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EP 160: Lessons from Recent HHS HIPAA Settlement Cases
In this episode, Chase Cannon and Suzanne Spradley discuss a few HIPAA lessons that employers can glean from recent Health and Human Services (HHS) enforcement settlements. Chase begins with an outline of HIPAA’s obligations in the group health plan context and HHS enforcement trends. Chase and...
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EP 159: The Role of PBMs, State PBM Legislation Under Federalism, and PBM Litigation Headlines
In this episode, Suzanne Spradley and Carol Wood discuss the role of pharmacy benefit managers (PBMs) and the recent proliferation of state laws that regulate PBMs. Next, Suzanne explains how these state PBM laws interact with federal laws, which are supreme. Suzanne reviews ERISA preemption and...
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EP 158: No Surprises Act, Out-of-Network Bills, and the Independent Dispute Resolution Process
In this episode, Suzanne Spradley and Chase Cannon discuss the No Surprises Act (NSA) and its impact on out-of-network (OON) billing, with the independent dispute resolution (IDR) process at its core. Suzanne starts with an outline of the NSA and OON billing, how surprise bills arise, and how the...
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EP 157: U.S. Senate Takes Up the One Big Beautiful Bill via Budget Reconciliation—What Does it Mean?
In this episode, Suzanne Spradley and Chase Cannon break down the Senate’s version of the One Big Beautiful Bill, released on June 16, 2025. Suzanne outlines the budget reconciliation process and how the so-called “Byrd Rule” comes into play. Suzanne and Chase discuss the similarities and...
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EP 156: Benefits Provisions in the Proposed Congressional “Big, Beautiful Bill”
In this episode, Chase Cannon and Suzanne Spradley outline the latest proposed bill from the U.S. House of Representatives, potentially up for a vote in the coming weeks. Chase outlines a key element missing from the proposed bill ‒ caps, cuts, or elimination of the so-called employer tax...
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EP 155: Discussion: Recent Study on Impacts of Capping Employer Healthcare Tax Benefits
In this episode, Suzanne Spradley and Chase Cannon review a recent industry focus-study on the economic impact of capping or eliminating the tax benefits associated with employer-provided health plans. Suzanne begins by providing a background on the employer-sponsored insurance tax breaks, their...
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EP 154: Some Beginning-of-Year FAQs on HSAs and HSA Eligibility
In this episode, Chase Cannon and Suzanne Spradley discuss some interesting questions relating to health savings accounts (HSAs), including basic eligibility, impermissible coverage, and employer responsibility when determining an individual employee’s HSA eligibility. Chase jumps in on a…
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EP 153: New Proposed HIPAA Security Rule Regulations Potential Impact on Employer Group Health Plans
In this episode, Suzanne Spradley and Chase Cannon discuss recently published proposed regulations relating to HIPAA’s Security Rule. Suzanne leads off with an overview of the HIPAA privacy and security rules generally, focusing on security — the usage of personal health information in electronic...
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EP 152: Understanding the Debate Surrounding Employer-Sponsored Insurance Tax Exclusion
In this episode, Suzanne Spradley and Chase Cannon discuss the debate relating to employer-sponsored group health plan coverage and insurance tax exclusion. Suzanne describes what is meant by employer-sponsored insurance (ESI) and the background on the tax breaks that employers and employees...
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EP 151: Problematic Wellness Indemnity Arrangements Bubbling Up Again!
In this episode, Chase Cannon and Suzanne Spradley discuss the recent revival of vendor-promoted pre-tax wellness arrangements that promise large tax savings for employers and employees with little employer investment. Chase leads off with a brief description of these programs and their purported...
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EP 150: PBM Regulation and Litigation and a Review of the J&J Case
In this episode, Suzanne Spradley and Chase Cannon review the current state and federal regulation of pharmacy benefit managers (PBMs), focusing on litigation surrounding recent state-enacted PBM rules. Suzanne starts off with a high-level description of PBMs and the role they play in the group...
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EP 149: Updates on Prescription Drug Importation in the US
In this episode, Suzanne Spradley and Chase Cannon discuss the US importation policies and rules aimed at lowering domestic prescription drug costs. Suzanne walks through the legalities of drug importation generally and then outlines the specific programs by which states can develop importation...
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EP 148: IRS Reminders: Employer Reporting Deadlines, Annual Numbers and an Alert on Wellness Vendors
In this episode, Chase Cannon and Suzanne Spradley remind employers about important ACA employer mandate reporting deadlines with the IRS, including a change in electronic reporting in 2024 for smaller employers. Chase also outlines some updated numbers relating to the federal poverty line (FPL),...
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EP 147: Background & Developments on the No Surprise Act & Independent Dispute Resolution Process
In this episode, Suzanne Spradley and Chase Cannon give an overview of the No Surprises Act (NSA) — a consumer health protection law that places certain requirements on providers and payers (insurers and group health plans). Suzanne describes the main requirements under the NSA and introduces the...
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EP 146: Recent HIPAA Settlements Shed Light on Employer Compliance w/ HIPAA Privacy & Security Rules
In this episode, Chase Cannon and Suzanne Spradley discuss employer compliance with the HIPAA privacy and security rules via lessons learned from three new HHS HIPAA settlement announcements. Chase leads off with a high-level review of the HIPAA rules for both fully and self-insured plans and the...
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EP 145: Recent Court Case on Interfering with Plan Participant’s ERISA 510 Rights
In this episode, Suzanne Spradley and Chase Cannon discuss a recent circuit-level decision relating to employee termination and its interaction with a participant lawsuit based on ERISA Section 510 (which prohibits an employer’s interference with a plan participant’s right to benefits). Suzanne...
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EP 144: Recent Developments at the State Level in CA, NY, TX, IL, OR, and ME
In this episode, Chase Cannon and Suzanne Spradley take a tour across the nation as they review several new regulatory developments in six states that could impact employers with employees or fully insured plans in those states. Chase outlines new or recently effective paid family leave rules in...
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EP 143: Recent Court Case Addresses ERISA Preemption of Oklahoma PBM Law
In this episode, Suzanne Spradley and Chase Cannon address a recent appellate-level court case that addresses ERISA preemption of a recently enacted Oklahoma state law regulating pharmacy benefit managers (PBM). Suzanne begins by laying the groundwork and history of ERISA and ERISA preemption....
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EP 142: Recent DOL Enforcement on MHPAEA and Applied Behavior Analysis (ABA) Therapy Exclusions
In this episode, Chase Cannon and Suzanne Spradley discuss recent enforcement on MHPAEA. Chase jumps in with a description of DOL’s enforcement approach, including working through TPAs to identify plans that have or had ABA therapy exclusions. Suzanne and Chase discuss the administrative…
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EP 141: Proposed Congressional Bills Aimed at Transparency and Pricing
In this episode, Suzanne Spradley and Chase Cannon review several new pieces of proposed federal legislation coming out of the House. Suzanne discusses the Transparency in Billing Act, which requires hospitals to have better and more accurate billing practices, policies and procedures with…
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EP 140: IRS Weighs in on Wellness Payments of Employer-Funded Fixed Indemnity Plans
In this episode, Chase Cannon and Suzanne Spradley discuss a recent IRS memo on wellness benefit payments via employer-funded fixed indemnity plans. Chase outlines the various iterations and structure of vendor-promoted wellness programs, which usually purport huge employment tax savings for...
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EP 139: Guidance and Litigation Relating to CAA Gag Clause Prohibitions
In this episode, Suzanne Spradley and Chase Cannon review the CAA’s prohibition on gag clauses in TPA and service provider contracts, as well as the employer’s obligation to attest to the removal of gag clauses (due December 31, 2023, for the first time). Suzanne outlines the challenges employers...
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EP 138: Preventive Care Litigation, HSA Updates and Some Interesting Issues on Form 5500 Schedule As
In this episode, Chase Cannon and Suzanne Spradley discuss updates on the ACA preventive care mandate litigation, including a stay issued by the Fifth Circuit Court of Appeals. HSA contribution limits become a topic of discussion, as the IRS recently published updated numbers. Chase and Suzanne...
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EP 137: National Debt, Debt Ceilings and the Impact on Healthcare and Group Health Plans
In this episode, Suzanne Spradley and Chase Cannon have a look at the national debt and debt ceiling and how they impact employers and their group health plans. Suzanne leads off with a discussion on the national debt and how Congress sets the debt ceiling. Suzanne and Chase go in depth on what a...
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EP 136: Recent HIPAA Violation Settlements from OCR
In this episode, Chase Cannon and Suzanne Spradley review several recent HIPAA violation settlements from the HHS Office for Civil Rights. Chase starts off by reviewing the general HIPAA obligations of fully and self-insured plans, including the importance of a HIPAA risk assessment. Chase and...
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EP 135: Texas Court Invalidates a Portion of the ACA’s Preventive Services Coverage Requirement
In this episode, Suzanne Spradley and Chase Cannon discuss a recent Texas court ruling that invalidates a portion of the ACA’s preventive services coverage requirement. Suzanne provides a background of the plaintiffs and their arguments, including a Constitutional problem with the way the...
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EP 134: IRS Mandates Electronic Filing for Smaller Employers
In this episode, Chase Cannon and Suzanne Spradley address recent IRS guidance that mandates electronic filing of certain tax forms – including Forms 1095-C – for smaller employers. Chase describes the background from Congress and the IRS and explains what it means now that any employer filing 10...
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EP 133: PBM Transparency: Potential State and Federal Activity
In this episode, Suzanne Spradley and Chase Cannon discuss potential activity at the federal and state level relating to PBM transparency. Suzanne begins the discussion by outlining a few proposals from Congress that attempt to hold PBMs accountable for unfair and deceptive practices that may be...
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EP 132: Public Health Emergencies, Telehealth Extensions & State Compliance Considerations – 2023
In this episode, Beth Allen and Chase Cannon look at several new developments for plan compliance in 2023. The two start with the recent announcement on the end of the COVID-19 public health emergency, which impacts the outbreak period and extension of timeframes for certain compliance deadlines....
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Ep 131: Healthcare Policy and Compliance Issues for Employers to Consider in 2023
In this episode, Suzanne Spradley and Chase Cannon highlight several areas of healthcare policy and compliance that will be on center stage in 2023. Suzanne starts with a discussion of transparency in healthcare and prescription drug costs, including several compliance requirements that will take...
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Ep 130: More COBRA Cases — Class Actions and COBRA Election Notices
In this episode, Suzanne Spradley and Chase Cannon discuss several recent COBRA cases. Suzanne starts by outlining several class action lawsuits filed against employers and plan sponsors relating to deficiencies in an employer health plan’s COBRA election notice. Suzanne and Chase discuss the use...
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Ep 129: Recent Court Rulings on COBRA and the ACA
In this episode, Chase Cannon and Suzanne Spradley discuss three recent court rulings—all at the district court level. Chase outlines the first case relating to a COBRA election notice failure, including takeaways for employers to enhance their notice distribution procedures. Chase and Suzanne…
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Ep 128: Fall Bills: Congress Considers Mental Health Services Proposals
In this episode, Suzanne Spradley and Chase Cannon walk through recent activity in the House and Senate relating to several new laws under consideration on coverage of mental health services. Suzanne starts by reviewing some potential changes relating to Medicare coverage of mental health…
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Ep 127: Benefits Aspects of the Inflation Reduction Act
In this episode, Chase Cannon and Suzanne Spradley discuss the benefits provisions of the recently-enacted Inflation Reduction Act. Chase walks through the extension of premium tax credit expansions through 2025, and the impact on employers with respect to the employer mandate penalties. Next,...
About this show
NFP introduces the Insights from the Experts podcast series. Each episode will showcase timely perspective from members of the NFP community, delivering information, analysis and solutions that address our clients’ most significant challenges.You can find archived episodes of Innovation Conversations at https://soundcloud.com/user-939810789.
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