Since the COVID-19 pandemic began back in early 2020, there’s been a myriad of group health plan COVID-19 relief measures, ranging from no-cost coverage for COVID-19 testing to extended COBRA election and payment and HIPAA special enrollment right entitlements. Some relief measures apply only during the COVID-19 “public health emergency” (PHE) – not to be confused with the COVID-19 “national emergency” – and some are permanent. Keeping track of what you need to do and how long the relief lasts can be a compliance challenge. Here’s a summary to help you keep it all straight.
Public health emergency extended through Jan. 15, 2022
The secretary of the Department of Health and Human Services (HHS) has authority to determine when a PHE exists, and may extend a PHE indefinitely in 90-day intervals. The COVID-19 PHE was first declared on Jan. 31, 2020, and has been renewed repeatedly, most recently on Oct. 15, 2021. Unless terminated earlier (or further extended, which seems quite possible), the PHE will run through Jan. 15, 2022.
During the COVID-19 PHE:
- Group health plans must provide COVID-19 diagnostic testing and related services without any participant cost sharing, prior-authorization requirements or other medical-management standards whenever a licensed healthcare or otherwise authorized provider deems the testing medically appropriate.
- An employee assistance program may remain an excepted benefit even if coverage for COVID-19 diagnostic testing is added.
- Employers may offer stand-alone telehealth to employees who are not eligible for other health coverage from that employer and avoid many group health plan mandates under ERISA, the ACA and other laws.
- The 60-day advance notice requirement for certain changes to a summary of benefits and coverage is waived.
- Group health plans may maintain grandfathered status even if they later revoke benefits added during the PHE.
- Some HIPAA privacy rules are relaxed.
This GRIST discusses these federal health coverage requirements and flexibilities, implementation issues, and open questions.
Other relief tied to the national emergency & outbreak period
A “national emergency” differs from the PHE described above. On March 13, 2020, former President Trump declared that the COVID-19 outbreak constituted a national emergency beginning March 1, 2020. On Feb. 24, 2021, President Biden renewed the national emergency declaration. The declaration will end automatically on March 1, 2022, unless renewed again by the President.
Based on the authority given to the various federal agencies, during the COVID-19 national emergency, group health plans must extend certain participant deadlines that would have expired during the “outbreak period”. The outbreak period began March 1, 2020, and will end 60 days after the end of the COVID-19 national emergency or other date announced by the enforcing agencies. For example, if the national emergency expires on March 1, 2022, the outbreak period will end 60 days later on April 30, 2022. The IRS and DOL released deadlines for health and other plans and for participants. See this GRIST for more information about the outbreak period relief.
The national emergency and outbreak period relief extends the:
- 30-day period (or 60-day period in certain circumstances) to request special enrollment rights under HIPAA.
- 60-day COBRA election period, the timeframe for making initial and on-going timely COBRA premium payments and the date for individuals to notify the plan of a COBRA qualifying event or determination of disability. Note that the application of the outbreak relief COBRA deadlines and extension were recently clarified in IRS Notice 2021-58.
- Deadlines for participants to file a benefit claim, to appeal a denied claim, and to request or perfect an external review of a denied claim.
The required extensions to the claims filing deadlines also extends the run-out periods for health flexible spending arrangements (general and limited purpose).
In light of the on-going national emergency, the applicable periods will be disregarded until the earlier of:
- One year from the date a particular individual or plan was first eligible for relief.
- 60 days from the end of the COVID-19 national emergency (i.e., the end of the outbreak period).
Once the relief expires, the paused periods for individuals and plans will resume.
First-dollar or predeductible telehealth coverage under HSA-qualifying HDHPs expires Jan. 1, 2022, for calendar-year plans
Temporary relief permits HSA-qualifying HDHPs to cover telehealth and other remote care services before individuals have met their deductible, without jeopardizing their eligibility to make or receive HSA contributions. Similarly, an otherwise HSA-eligible individual may receive coverage for telehealth and other remote care services from a stand-alone vendor outside of the HDHP before satisfying the HDHP deductible, without affecting their eligibility to make or receive HSA contributions. This important relief is not tied to either the PHE or national emergency described above, and will expire at the end of the plan year that began in 2021 (e.g., Dec. 31, 2021 for calendar-year plans), unless extended or made permanent by Congress. HDHPs that took advantage of this relief should begin charging participants for any predeductible telehealth services that are not HSA-compatible preventive care.