top of page

COVID Emergency Periods Coming to an End: New Guidance Issued for Group Health Plans

The federal COVID-19 Public Health Emergency and National Emergency are officially coming to an end. The federal agencies have issued guidance in an effort to ensure that workers and their families are aware of any changes that may be coming their way due to the termination of the emergencies. The U.S. Department of Labor (DOL) has also expressed their commitment to work with employers and plan sponsors to ensure a smooth transition as the federal government unwinds some of the policies that have been in place during the COVID emergencies. Below is an outline of immediate relevant facts for your consideration.


Public Health Emergency in Effect Through May 11th The U.S. Department of Health and Human Services declared the Public Health Emergency (PHE) end date as May 11, 2023. When the PHE ends, health plans will no longer be required to cover COVID diagnostic tests and related services without cost sharing. Health plans will still be required to cover recommended preventive services, including COVID immunizations, without cost sharing, but this coverage requirement will be limited to in-network providers.


National Emergency Ended April 10th President Biden signed a resolution ending the COVID-19 National Emergency (NE). Previously it was announced that the end date to both the NE and the PHE was May 11th, but the bipartisan legislation signed by the President terminated the NE as of April 10, 2023. Various employee benefit plan deadlines had been extended by disregarding an “Outbreak Period” (OP) from March 1, 2020, until 60 days after the announced end of the NE, or another date as announced by the agencies. Since the NE now has been determined to end on April 10, 2023, the 60 day period would end on June 9, 2023 (rather than July 10, 2023 as previously predicted). But we understand the DOL has indicated that it will continue to use the May 11 date, meaning the OP would end on July 10, 2023 (60 days after that date). We are hopeful the agencies will issue formal, written guidance to confirm the end of the OP. Once the OP ends, health plans can return to their nonextended deadlines for COBRA, HIPAA special enrollment and claims timelines.


Guidance Issued The DOL is encouraging plan sponsors and employers to review guidance issued on March 29, 2023, addressing how certain health plan requirements related to the COVID pandemic will change when the emergency periods end. While this guidance was issued before the resolution ended the NE, the clarifications regarding changes to benefits after the end of the emergency periods and the reinstatement of normal deadlines still apply. While the guidance does not provide any new information beyond what we have already shared in prior Updates, here and here, employers should review the guidance and be familiar with it:

  • The DOL Frequently Asked Questions (FAQs) address how the end of the PHE affects requirements to cover COVID diagnostic testing and vaccines, as well as how the end of the NE affects extensions of certain time frames for employee benefit plans and their participants and families. Specifically, the eight FAQs address:

    • Coverage for COVID diagnostic testing;

    • Rapid coverage of preventive services and vaccines for coronavirus;

    • Extension of certain timeframes for employee benefit plans subject to ERISA and the Code, pursuant to the COVID OP;

    • Special enrollment in group health plans after loss of eligibility for Medicaid or CHIP coverage or after becoming eligible for premium assistance under Medicaid or CHIP; and

    • Special benefits for COVID-19 testing and treatment under health savings accounts (HSAs)/high deductible health plans (HDHPs), providing that an individual covered by an HDHP that provides medical care services and items purchased related to testing for and treatment of COVID-19 prior to the satisfaction of the applicable minimum deductible may continue to contribute to an HSA until further guidance is issued.


Next Steps for Employers and Plan Sponsors

  • If plans are making changes to coverage for COVID-19 tests (or other benefits) or to coverage for COVID-related preventive services, be sure to communicate those changes, including any key limitations, to individuals in advance of those changes taking effect.

  • The Departments encourage plans and issuers to notify participants of key information regarding coverage of COVID diagnosis and treatment, including testing. This includes the date when the plan will stop coverage if the plan chooses to no longer cover COVID diagnostic tests or when the plan will begin to impose cost-sharing requirements, prior authorization, or other medical management requirements on COVID tests, to the extent applicable under the plan or coverage. We note that general consensus based on Conner Strong clients indicates that most intend to discontinue over the counter COVID test coverage and cover regular COVID tests (at lab/provider) with normal plan cost sharing (no longer covered at 100%).

  • Plans need to coordinate with COBRA and other vendors and administer the proper extension deadlines as applied to impacted individuals. Several timeframes were extended for many plans to give individuals more time to take action such as requesting special enrollment to join their employment-based health plan, electing COBRA continuation coverage and paying COBRA premiums, and submitting health plan claims and appeals.

The Biden administration has stated it will continue working with federal agencies to wind down the COVID emergencies.


Additional resources on the ending of the emergency periods are available on the Department of Labor’s Response to COVID-19 website. Conner Strong & Buckelew will provide updates and additional guidance as new information becomes available. Please contact your Conner Strong & Buckelew account representative toll-free at 1-877-861-3220 with any questions. For a complete list of Legislative Updates issued by Conner Strong & Buckelew, visit our online Resource Center.

33 views0 comments

Related Posts

See All

IRS PCORI Fees Due by July 31, 2024

The Patient-Centered Outcomes Research Institute (“PCORI”) fee was established as part of the Affordable Care Act (“ACA”) to fund medical research through the PCORI Institute. Employers and plan spons

Reminder: RxDC Reporting Due June 1, 2024

The Centers for Medicare and Medicaid Services (CMS) is now accepting Prescription Drug Data Collection (RxDC) submissions for “reference year” 2023. Data must be submitted through the RxDC Health Ins

Comments


bottom of page