The US Department of Labor’s Employee Benefits Security Administration (EBSA) has announced updated enforcement priorities for fiscal year 2026. These changes signal where EBSA will focus its investigative and enforcement efforts related to group health plans, with an emphasis on participant protection and higher-risk compliance issues.
For employers and plan sponsors, the announcement provides a helpful roadmap for where regulators are most likely to focus and where proactive compliance efforts may reduce risk.
KEY HEALTH PLAN ENFORCEMENT PRIORITIES
EBSA intends to prioritize investigations in the following health plan areas:
- Cybersecurity and data protection: Health plan data security remains a top concern. EBSA will continue to examine how plans protect participant information, including oversight of third-party administrators and vendors, cybersecurity policies, and incident-response practices.
- Mental health and substance use disorder parity: EBSA will continue enforcement of mental health parity rules. Investigations will focus on whether plans create barriers to mental health or substance use disorder benefits, including unjustified treatment exclusion, claims processes, unreasonable limits on care, and compliance with required parity analyses.
- Surprise billing compliance: EBSA’s efforts here will be focused on enforcing the No Surprises Act (NSA), which is designed to protect individuals from unexpected medical bills in situations where they typically cannot choose their provider. EBSAs investigations will focus on whether health plans treat emergencies appropriately; apply in-network cost sharing to services provided under the NSA; provide proper notice and disclosures; comply with other NSA protections, such as avoiding improper restrictions for protected services; and comply with payment timeliness during open negotiations and the independent dispute resolution process.
- Protections of employee contributions: Health plans that involve employee contributions, such as premium payments or health flexible spending arrangements, remain an enforcement focus. EBSA will scrutinize how participant contributions are collected, handled, and remitted to ensure they are not misused.
CONTINUED SCRUTINY OF MULTIPLE EMPLOYER WELFARE ARRANGEMENTS
Although not a formal national enforcement project, EBSA reaffirmed its ongoing efforts to identify abusive or fraudulent Multiple Employer Welfare Arrangements (MEWAs). Employers participating in MEWAs should carefully evaluate the arrangement’s compliance, financial stability, and regulatory history.
WHAT THIS MEANS FOR PLAN SPONSORS
Plan sponsors may want to:
- Review cybersecurity policies and vendor oversight practices
- Confirm mental health parity analyses are complete and up to date
- Evaluate claims processing and appeals procedures
- Assess compliance with the Nor Surprises Act requirements
- Ensure employee contributions are handled promptly and properly.
Taking proactive steps in these areas can help reduce enforcement risk and improve plan operations.
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