The federal public health emergency declaration due to the COVID-19 pandemic has been extended to January 22, 2021. The Department of Health and Human Services (HHS) originally declared the public health emergency on January 31, 2020, and the declaration was previously renewed twice this year, in April and July. Public health emergency declarations are generally effective for 90 days.Sponsors and administrators of group health plans should be aware that certain benefit related deadlines are extended due to the public health emergency. Guidance issued by the US Department of Labor and the Internal Revenue Service extends numerous deadlines specific to Claims for Benefits and External Reviews, COBRA, and HIPAA Special Enrollment. From the beginning of the outbreak on March 1, 2020 through the date 60 days after the public health emergency ends, deadlines are extended due to the challenges participants and beneficiaries may face filing timely notice. See Infographic here.
HHS has encouraged plan sponsors of non-Federal governmental group health plans to provide relief similar to that specified for ERISA plans to participants and beneficiaries, and encourages states and health insurance issuers offering coverage in connection with a group health plan to enforce and operate consistently with these relief provisions.
HIPAA Special Enrollment Periods: The declaration extends the 30- and 60-day HIPAA special enrollment periods. Thirty-day special enrollment periods may apply when eligible employees or dependents lose eligibility for other health plan coverage in which they were previously enrolled; or when an eligible employee acquires a dependent through birth, marriage, adoption, or placement for adoption. Sixty-day special enrollment periods may apply due to changes in eligibility for state premium assistance under the Children’s Health Insurance Program (CHIP).
COBRA: COBRA deadlines for extension of health coverage have been extended until 60 days after the public health emergency ends. This includes the 30- or 60-day deadline for employers or individuals to notify the plan of a qualifying event; the 60-day deadline for individuals to notify the plan of a determination of disability; the 14-day deadline for plan administrators to furnish COBRA election notices; the 60-day deadline for participants to elect COBRA; and the 45-day deadline in which to make a first premium payment and 30-day deadline for subsequent premium payments.
Claims Procedures: Extended deadlines apply 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 group health plans.
External Review Process: Extended deadlines apply to non-grandfathered group health plans for providing a state or federal external review process after the plan’s internal appeals procedures are exhausted. Plans must allow at least four months after the receipt of a notice of adverse benefit determination for a participant to request an external review using the federal review process. The timeframe to remedy an incomplete request for review is also extended. Plans regulated by state agencies may impose different deadlines.
Group health plans and responsible plan fiduciaries will not be considered in violation 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 has also been extended.
Provisions relating to group health plans under the Family First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief and Economic Security (CARES) Act may impose different deadlines. Because circumstances around the COVID-19 pandemic are changing constantly, such provisions may be updated according to conditions. Please refer to our prior guidance on FFCRA and the CARES Act, as well as details on the application of these group health plan deadlines.
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