After more than three years, the COVID-19 public health emergency (“COVID-19 PHE”) was declared to be over officially on May 11, 2023. What does the end of the public health emergency mean for health benefits, in particular, COVID-19 testing and vaccines, extended time frames granted for certain health benefit actions, and “continuous enrollment” for Medicaid/CHIP?
COVID-19 Testing and Vaccines
During the COVID-19 PHE, group health plans and health insurance issuers offering group or individual health coverage were required to cover COVID-19 diagnostic testing, including over-the-counter tests, at no cost to individuals. Now, any plan or issuer providing coverage for COVID-19 diagnostic testing may impose cost-sharing, prior authorization, or other medical management requirements. Additionally, under normal circumstances, a High Deductible Health Plan is not permitted to provide benefits in any year until the minimum deductible for that year is met. However, during the PHE, there was specific relief from this requirement with respect to COVID-19 diagnostic testing. This relief will end on January 1, 2025 and COVID-19 diagnostic testing may not be provided under a High Deductible Health Plan without a deductible.
While many plans must continue (for now) to cover COVID-19 vaccines as preventive services at no cost to employees from an in-network provider, the requirement to cover COVID-19 vaccines out-of-network has lapsed with the end of the COVID-19 PHE.
How long do extended time frames for COBRA, HIPAA special enrollment, ERISA claims procedures, and external review of medical claims last?
For the events or circumstances listed below, the extended time frames (“disregarded period”) generally continue until whichever of the below comes first:
1) one year from the date the action would have otherwise been required
2) 60 days after the end of the COVID-19 National Emergency (the “Outbreak Period”), which is July 10, 2023
The disregarded periods extend the following periods and dates:
- The 60-day election period for COBRA continuation coverage
- The date for making initial COBRA premium payments
- The date for individuals to notify the plan of a qualifying event or determination of disability
- The date for providing a COBRA election notice
- The 30-day period (or 60-day period, if applicable) to request HIPAA special enrollment
- The deadline for individuals to file a benefit claim under the plan’s claims procedure
- The date that claimants may file an appeal of an adverse benefit determination under the plan’s claims procedure
- The date that claimants may file a request for an external review after receipt of an adverse benefit determination or final internal adverse benefit determination (varies by state law)
- The date that a claimant may file information to fulfill a request for external review after discovering that the request was not complete (varies by state law)
Medicaid/CHIP Coverage and Continuous Enrollment
During the COVID-19 PHE, certain protections were adopted to ensure individuals did not lose Medicaid/CHIP coverage (referred to as “continuous enrollment”). During continuous enrollment, state Medicaid agencies couldn’t unenroll anyone unless they asked to be unenrolled, moved out of state, or died. In December 2022, Congress passed an appropriations bill that ended continuous enrollment on March 31, 2023, allowing states to resume Medicaid coverage terminations, effective April 1, 2023. States have started to unwind continuous enrollment and resume eligibility determinations for Medicaid coverage. Some sources estimate that Medicaid enrollment increased by 30% during the pandemic. This process is expected to take several years.
Final Thoughts for Plan Administrators Post COVID-19
To maintain your plan’s compliance, administrators should review and revise all “pandemic era” communications addressing any of these matters and inform participants of changes in advance. Additionally, be aware that Medicaid enrollees who declined employer coverage may be eligible for HIPAA special enrollment under the employer’s plan, straining your resources. Finally, it would be wise to work with benefits staff/third-party administrators to ensure your plans’ records are up to date. It is possible that there could be an unprecedented number of COBRA enrollees, retroactive premium payments, and benefit claims and appeals. As a plan administrator, you could be under pressure to meet the deadlines to respond to these matters.
For examples on how to apply the extended time frames, see:
- DOL “FAQs about Families First Coronavirus Response Act, Coronavirus Aid, Relief, and Economic Security Act, and Health Insurance Portability and Accountability Act Implementation Part 58” (March 29, 2023)
- 85 FR 26351 (May 4, 2020) – DOL, Department of Treasury, and the Internal Revenue Service Joint Notification of Extensions of Certain Timeframes for Employee Benefit Plans, Participants and Beneficiaries Affected by the COVID-19 Outbreak
The pandemic was unprecedented, in the effect it had on our healthcare and benefits systems. The status of plans, coverage and adjustments can be a confusing web of jargon and timelines. For counsel on how to ensure your plan, expectations and communications are aligned and compliant in this post-COVID era, schedule a consultation with Anna or one of our team members.