On January 30, 2023, President Biden announced that the COVID-19 National Emergency and the COVID-19 Public Health Emergency declarations, set to expire on March 1 and April 11 respectively, will be extended until May 11, 2023 and then terminated after that date. This update summarizes the impact of the end of these states of emergency on group health plans and retirement plans.
Impact on Retirement Plans
Retirement plans are impacted by the end of the National Emergency, which first took effect on March 1, 2020. As we explained in a previous Update, the Department of Labor and Internal Revenue Service issued guidance temporarily extending various deadlines applicable to plans and to participants until the earlier of (a) one year from the date an individual was first eligible for relief or (b) 60 days after the end of the National Emergency.
For retirement plans, the end of the National Emergency means that the following deadlines will no longer be tolled as of July 10, 2023 (60 days after the end of the National Emergency) or the date on which an individual has been eligible for a specific deadline extension for one year, if earlier:
- Deadline to file a benefit claim under the plan’s claims procedure;
- Deadline to file an appeal of a claim denial under the plan’s appeal procedure.
For example, assume a participant received a notice of a benefit claim denial on April 1, 2021. Normally (if there had been no National Emergency period), the participant would be required to file an appeal within 60 days of receipt of the denial notice under the plan’s appeals procedures (by May 31, 2021). However, as a result of the National Emergency, the participant’s deadline to file an appeal was extended to the earlier of one year (May 31, 2022) or 60 days after the end of the National Emergency (July 10, 2023). Since May 31, 2022 is sooner, the participant’s deadline to file an appeal ended on May 31, 2022.
Impact on Group Health Plans
Group health plans are affected by the end of both the National Emergency and the Public Health Emergency declarations.
After the end of the National Emergency, the following deadlines will no longer be tolled as of July 10, 2023 (60 days after the end of the National Emergency) or the date on which an individual has been eligible for a specific deadline extension for one year, if earlier:
- 30-day period (or 60-day period in certain circumstances) to request enrollment in the Plan due to a HIPAA special enrollment event;
- 60-day period to elect COBRA continuation coverage;
- 30-day grace period to pay COBRA premiums;
- 45-day period to pay the first COBRA premium after electing COBRA;
- Deadline to file a benefit claim under the plan’s claims procedure;
- Deadline to file an appeal of a claim denial under the plan’s appeal procedure;
- Deadline to request an external review of a certain denied appeals and the date by which information must be received to perfect a request for external review.
The Public Health Emergency was first declared by the Department of Health and Human Services on January 27, 2020 and has been extended several times since that date. As discussed in a previous Update, the Families First Coronavirus Response Act (“FFCRA”) and the Coronavirus Aid, Relief and Economic Security Act (“CARES Act”) required group health plans to provide coverage for COVID-19 tests (including tests administered by providers or purchased over-the-counter by participants) and related services, as well as COVID-19 vaccines, without cost-sharing, prior authorization, or other medical management requirements. This requirement extended to coverage for services and vaccines provided by out-of-network providers.
Once the Public Health Emergency ends on May 11, 2023, group health plans will no longer be required to cover COVID-19 tests and related services without cost sharing, prior authorization, or other medical management requirements, whether in-network or out-of-network. Group health plans should review their current rules relating to this coverage and discuss if they wish to make any change.
Non-grandfathered group health plans still are required to cover the COVID-19 vaccine without cost sharing under the Affordable Care Act (“ACA”) as a routine immunization recommended by the Advisory Committee on Immunization Practices for the CDC as part of the ACA’s preventative care benefit. Because the ACA does not require coverage of “preventive” services provided out-of-network, group health plans should review this out-of-network coverage and discuss if they wish to make any change on and after May 11, 2023.
Please contact Slevin & Hart for more information about how this issue affects your plan.
Attorneys
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