The Department of Health and Human Services (HHS) has again extended the public health emergency (PHE) declared for the COVID-19 pandemic. This is the fourth extension of the PHE, which was initially declared on January 31, 2020 (retroactive to January 27, 2020). HHS could terminate the PHE earlier than April 21, 2021 or extend it again.
This PHE declaration is important to health plan sponsors because various group health plan (GHP) related deadlines are extended due to the PHE (unless the agencies announce a different end date for purposes of these extensions). For example, the PHE will determine the period of time during which GHPs and insurers must pay for COVID-19 tests and related services without charging cost sharing. In addition, non-grandfathered plans must cover vaccines in network as a preventive benefit, but during the PHE must also cover vaccines on an out-of-network basis.
By contrast, the COVID-19 “National Emergency” declared by President Trump began on March 1, 2020 and is still, as of now, set to end automatically on March 1, 2021 unless it is renewed by the President. Joint DOL and IRS guidance extended numerous GHP participant deadlines that would have expired during a defined “outbreak period” that began March 1, 2020. Pursuant to that guidance, the outbreak period is set to end 60 days after the end of the National Emergency (or such other date as announced by the agencies). So if the National Emergency ends on March 1, 2021, the outbreak period will end on April 30, 2021.
These rules effectively “freeze” certain timely deadlines for the duration of the outbreak period as follows:
COBRA: Multiple COBRA deadlines are extended until after the outbreak period ends, including (1) the 30- or 60-day deadline for employers or individuals to notify the plan of a qualifying event; (2) the 60-day deadline for individuals to notify the plan of a determination of disability; (3) the 14-day deadline for plan administrators to furnish COBRA election notices; (4) the 60-day deadline for participants to elect COBRA; and (5) the 45-day deadline in which to make a first premium payment and 30-day deadline for subsequent premium payments.
HIPAA Special Enrollment: The 30- and 60-day HIPAA special enrollment periods (SEPs) are extended. Thirty-day SEPs may be triggered when eligible employees or dependents lose eligibility for other health plan coverage in which they were previously enrolled, and when an eligible employee acquires a dependent through birth, marriage, adoption, or placement for adoption. Sixty-day SEPs may be triggered by changes in eligibility for state premium assistance under the Children’s Health Insurance Program.
Claims Procedures and External Review Process: The deadlines are extended for individuals to file claims for benefits, for initial disposition of claims, and for providing claimants a reasonable opportunity to appeal adverse benefit determinations under ERISA plans and non-grandfathered GHPs. Non-grandfathered GHP deadlines have been extended for providing a state or federal external review process following exhaustion of the plan’s internal appeals procedures. (State deadlines may vary; plans using a federal external review process must allow at least four months after the receipt of a notice of adverse benefit determination in which to request an external review.) Other deadlines that apply for perfecting an incomplete request for review are also extended.
In addition, GHPs and responsible plan fiduciaries will not be treated as having violated ERISA if they act in good faith and furnish any notices, disclosures, or documents that would otherwise have to be furnished during the outbreak period “as soon as administratively practicable under the circumstances.” The deadline for furnishing advance notice of modifications to the summary of benefits and coverage (SBC) has also been extended.
Conner Strong & Buckelew will provide alerts and updates as new information becomes available and pronouncements are made about the end of the National Emergency and the PHE and as guidance is issued that otherwise extends, terminates, or modifies deadline relief. 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.