01 Apr Preparing for the End of the COVID-19 Public Health Emergency
On January 27, 2020, the U.S. Department of Health and Human Services declared a 90-day Public Health Emergency in response to the COVID-19 pandemic. This action enabled the federal government to enact many mandates and temporary rules for group health plans covered by the Employee Retirement Income Security Act (ERISA) for a 90-day period.
The COVID-19 Public Health Emergency been renewed each 90 days since its original effective date. However, the Biden Administration has announced the official end to the Public Health Emergency on March 31, 2023. What do employers with plans covered by ERISA need to know?
COVID-19 Public Health Emergency
ERISA is a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for plan participants. For example, ERISA requires employers to provide employees with important information regarding plan features and funding, and sets minimum standards for participation, vesting, benefit accrual and funding.
The end of the Public Health Emergency is important because it determines the period during which group health plans and insurers must pay for COVID-19 tests and related services without cost sharing. It is especially important for plan sponsors to be aware of the following:
- Plans will no longer be required to cover costs of COVID tests, vaccines and boosters from out-of-network providers without cost sharing (e.g., deductibles and co-pays), prior authorization or other medical management requirements.
- Plans will still be required to cover vaccines from in-network providers for free according to the Coronavirus Aid, Relief and Economic Security Act.
- Plan sponsors can no longer offer free telehealth and remote care services for participants who are not eligible for major medical coverage.
This means plan sponsors should review coverage of COVID-19 and related costs to determine how the plan will deal with them going forward. They should also ensure that all plan-related documents and participant communications accurately describe coverage, exclusions and limitations following the end of the Public Health Emergency.
COVID-19 Outbreak Period
Per federal law, the COVID-19 Outbreak Period is effective from March 1, 2020, to the earlier date of the following: a) one year from the date an individual is first eligible for relief or b) the end of the Outbreak Period, which is 60 days after the end of the Public Health Emergency.
Overall, benefits plan sponsors have 60 days after the announced end of the Outbreak Period , or until May 31, 2023, to revert to several pre-pandemic deadlines, including:
- 30-day or 60-day Health Insurance Portability and Accountability Act (HIPAA) special enrollment
- 60-day election period for Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation coverage
- 30-day and 45-day COBRA premium payment deadlines
- 60-day deadline to notify COBRA administrators of certain qualifying events or new disability
- Deadline to file a benefit claim and to appeal an adverse determination under the plan’s claims procedures
- Four-month deadline to request an external review of an adverse benefit determination
To prepare for these changes, employers should review benefit team protocols, plan-related documents and participant communications to ensure they accurately describe the applicable deadlines. This may present added challenges because each individual has their own applicable deadline.
A trusted third-party benefits administrator such as PacFed can help answer any questions you may have and make this transition go as smoothly and efficiently as possible.
For more information, please visit:
https://www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html
https://www.cms.gov/blog/creating-roadmap-end-covid-19-public-health-emergency
Pacific Federal is a Zenith American company and subsidiary of Harbour Benefit Holdings, Inc.