US NAIC Spring 2026 National Meeting Highlights: Employee Retirement Income Security Act (ERISA) and Alternative Health Coverage (B) Working Group

The Employee Retirement Income Security Act (ERISA) and Alternative Health Coverage (B) Working Group (the “ERISA Working Group”) of the U.S. National Association of Insurance Commissioners (“NAIC”) met on March 24, 2026 at the NAIC Spring 2026 National Meeting in San Diego, California. In addition to routine matters, the ERISA Working Group discussed the following.  

Guidance Document: ERISA Preemption and State PBM Laws

The ERISA Working Group discussed comments received on the ERISA Preemption and State Pharmacy Benefit Manager (PBM) Laws guidance document (the “Guidance Document”). The Guidance Document is intended to provide guidance to state regulators and legislators as they consider measures for PBM oversight. The Guidance Document provides an overview of ERISA preemption, cases addressing ERISA preemption of state PBM laws, lessons learned from such legal challenges and principles to apply to the question of whether ERISA may preempt the state law at issue.

With respect to lessons learned from legal challenges to ERISA preemption, the Guidance Document notes that it is important for states to carefully consider both the entities to which PBM legislation applies in addition to the content and focus of the legislation’s specific provisions. Also, the Guidance Document notes that for new legislation, it is important that severability language is included. As a result of these lessons learned, the Guidance Document recommends a set of principles for regulators and legislators to apply to PBM laws that first analyze to whom do the PBM laws apply and then it focuses on  the content and focus of the specific provisions in the state PBM laws.

The ERISA Working Group noted that it received comments recommending that the Guidance Document be revised  to include citations and references to existing language in the NAIC’s publication, Health and Welfare Plans Under the Employee Retirement Income Security Act: Guidelines for State and Federal Regulation (the “ERISA Handbook”). The ERISA Working Group explained that the ERISA Handbook and Guidance Document are intended to remain separate publications for now, but agreed to include references in the Guidance Document where appropriate. The  ERISA Working Group also received comments recommending that the Guidance Document include policy statements on PBM matters. The ERISA Working Group declined, explaining that the Guidance Document is intended to be a factual resource rather than a policy document. Finally, the ERISA Working Group received comments recommending that the Guidance Document include a list of ongoing litigation relating to ERISA matters so interested parties could track the development of such case law. The Working Group indicated it would consider this suggestion. The Working Group plans to continue revising the Guidance Document based on comments received.

Other Matters

In addition to the Guidance Document, the ERISA Working Group also discussed the following matters:

• Level-Funded Plans: The ERISA Working Group was previously asked by the Regulatory Framework to look at level-funded plans. The ERISA Working Group has since developed an initial draft of a paper addressing level-funded plans, and asked for volunteers to join a small working group to review and finalize the paper so it could be exposed for public comment.
• New 2026 Charge: The ERISA Working Group then noted its new charge to monitor, analyze, and report, as necessary, developments related to excepted benefits coverage; short-term, limited-duration (STLD) coverage; health-sharing ministry coverage (HSMC); and coverage that is offered and marketed as a substitute for, or an alternative to, comprehensive major medical coverage. The ERISA Working Group requested feedback on areas to focus on in furtherance of this charge. Stakeholders were asked to reach out with suggestions by April 30, 2026. One idea proposed by the ERISA Working Group was to create a repository of state laws on alternative coverage options. Other ideas proposed included a proposal to review enforcement actions on improper marketing of such products, a review of what states accept as excepted benefits, a data call on where people are getting medical coverage, and further consideration of the Supplementary and Short-Term Health Insurance Minimum Standards Model Act (#170) and Model Regulation to Implement the Supplementary and Short-Term Health Insurance Minimum Standards Model Act (#171).

To view additional updates from the US NAIC Spring 2026 National Meeting, visit our meeting highlights page.