National Public Health Emergency Extension Benefit Plan Impact

On July 23, 2020, the Secretary of Health and Human Services (“HHS”), Alex Azar, declared the Public Health Emergency, scheduled to end on July 25, 2020, will once again be extended for an additional 90 days. As a result, numerous temporary benefit plan changes remain in effect.

 

Important Definitions 

Emergency Period. HHS Secretary Azar issued a Public Health Emergency, beginning January 27, 2020. This Emergency Period is now set to expire on October 23, 2020 (unless further extended or shortened by HHS).

Outbreak Period. The Outbreak Period runs from March 1, 2020, until 60 days after the announced end of the National Emergency, which should likely mean no earlier than December 22, 2020. 

While there are other temporary benefit plan provisions and changes that are now allowed due to the public health emergency, only those provisions directly impacted by the public health emergency extension are summarized below.

 

Benefit Plan Changes in Effect Through the End of the Emergency Period 

COVID-19 Testing. All group health plans must cover COVID-19 tests and other services resulting in an order for a test without cost-sharing, prior authorization, or medical management. It includes both traditional and non-traditional care settings in which a COVID-19 test is ordered or administered. 

Excepted Benefits and COVID-19 Testing. An Employee Assistance Program (“EAP”) will not be considered to provide significant medical benefits solely because it offers benefits for diagnosis and testing for COVID-19 during the Emergency Period and will maintain status as an excepted benefit.

Expanded Telehealth and Remote Care Services. Large employers (51 or more employees) with plan years that begin before the end of the Emergency Period may offer telehealth or other remote care services to employees (and their dependents). They are not eligible for other group health plan coverage provided by the employer. 

Summary of Benefits and Coverage (“SBC”) Changes. Group health plans may notify plan members of changes as soon as practicable and are not held to the 60-day advance notice requirement for changes affecting the SBC during the plan year. They are not held to the advance notice requirement for the reversal of COVID-19 changes once the Emergency Period expires. The plan members are made aware of any increase and or decrease in plan benefits summarized on the SBC. 

Grandfathered plans. If a grandfathered plan enhanced benefits related to COVID-19 for the duration of the Emergency Period (e.g., added telehealth or reduced or eliminated cost-sharing), the plan will not lose grandfathered status if the changes are later reversed when the Emergency Period expires.

 

Benefit Plan Changes in Effect Through the end of the Outbreak Period 

Group health plans, disability, and other employee welfare benefit plans will disregard the period from March 1, 2020, until the end of the Outbreak Period when determining the following:

COBRA. Timeframe for the employer to provide a COBRA election notice; the 60-day election period for a qualified beneficiary to elect COBRA; the COBRA premium payment deadlines (45 days for the initial payment, the 30-day grace period for ongoing payments); the deadline to notify the plan of qualifying events or disability determinations. 

HIPAA Special Enrollment. 30 days (60 days for Medicaid/CHIP events) to request a special enrollment right due to loss of health coverage, marriage, birth adoption, or placement for adoption. 

ERISA Claims Deadlines. Timeframe to submit a claim and appeal of an adverse benefit determination. For non-grandfathered medical plans, the timeline to request external review and perfect an incomplete request.

• The claim deadlines include a health FSA or HRA that occurs during the Outbreak Period. 

Fiduciary Relief of Certain Notification and Disclosure Deadlines for ERISA Plans. A plan will not violate ERISA for failure to timely furnish a notice, disclosure, or document throughout the Outbreak Period if the plan and fiduciary operate in good faith. A notice, disclosure, or document needs to be furnished as soon as administratively practicable (which may include the use of electronic means such as email and text messages).

 

Employer Action 

Employers should continue to adhere to the national pandemic-related benefit changes and expanded timeframe for providing COVID-19 coverage and other required plan notifications. State and local emergency measures may expire at different times. They could impact employee benefit plans (such as insured group health plans) and other state and or local programs (such as paid leave) differently than the timeframes required under federally regulated program requirements. 

 

This document is designed to highlight various employee benefit matters of general interest to our readers, and not intended to interpret laws or regulations or address specific client situations. It would be best if you did not act or rely on any information contained herein without seeking an attorney or tax professional’s advice. ©2020 United Benefits, LLC. All Rights Reserved. CA Insurance ID MCFPPRPRPZ.