After more than three years of the COVID-19 pandemic, the Biden administration has announced the end of both the National Emergency and the Public Health Emergency on May 11, 2023. As a result, the impacts these declarations had on employee benefit plans will sunset. Benefit administrators and plan sponsors need to prepare employees for the transition back to a pre-pandemic world.

National Emergency

In May 2020, the Departments of Labor and Treasury issued guidance that extended the deadlines to elect COBRA, pay COBRA premiums, elect HIPAA special enrollment, and file benefit claims, appeals, and external review requests. These suspensions (tied to the National Emergency declaration issued in March 2020) are known as the “Outbreak Period Extensions.” The Outbreak Period will end on July 10, 2023 – 60 days after the National Emergency ends.

These suspended timeframes will begin to run again on pre-pandemic timelines, effective July 11, 2023:

  • COBRA Qualifying Event and Disability Extension Notices – The 60-day deadline by which qualified beneficiaries must notify the plan of certain qualifying events (e.g., divorce or legal separation or a dependent child ceasing to be a dependent under the terms of the plan) or disability determination.
  • COBRA Election – The 60-day deadline to elect COBRA continuation coverage.
  • COBRA Premium Payments – The 45-day (for the initial payment) and 30-day (for subsequent payments) deadlines to pay COBRA premiums.
  • HIPAA Special Enrollment Period – The 30-day deadline (in some instances, 60 days) to request enrollment in a group health plan following a special enrollment event (i.e., birth, adoption, or placement for adoption of a child, marriage, loss of other health coverage, or eligibility for a state premium assistance subsidy).
  • COBRA Election Notice – The 14-day deadline (44 days when the employer is the plan administrator) for a plan administrator to provide a COBRA election notice to qualified beneficiaries
  • Claims and Appeals – Deadline extensions for participants to file a benefit claim and the deadlines to appeal an adverse benefit determination or request an external review, including FSAs and HRAs.

Plan sponsors and benefit administrators should update employee communications and adjust administrative processes to reflect the return to normal timeframes.

Public Health Emergency

Under the Public Health Emergency (PHE) enacted in January 2020, all Americans have access to free COVID-19 tests and vaccines. As the PHE and federal funding come to an end, Medicare, Medicaid, and private insurers will all make decisions on how to cover COVID-related healthcare.

Whereas states and the federal government may continue some services at no cost for Medicaid and Medicare enrollees, private health insurers will need to determine how they will cover these services, including whether services will be subject to normal out-of-pocket costs.

  • COVID-19 Testing – Employer group plans are expected to cover in-network COVID testing but will probably implement cost sharing like other diagnostic testing. Access to free at home tests kits will end when the government supply runs out.
  • Vaccines – All non-grandfathered plans must continue to cover vaccines received from in-network providers at no cost as a preventive service under the ACA.
  • Treatments – Most private insurers will still cover medications such as Paxlovid, but these will likely be subject to deductibles or copays, just like other medications.

Plan sponsors will need to communicate any coverage changes to employees and ensure all plan-related documents accurately describe coverage, exclusions, and limitations.

Impacts to Medicaid and CHIP Coverage

During the PHE, states were required to provide “continuous coverage” to Medicaid and CHIP beneficiaries, even when beneficiaries no longer qualified for the programs. As of April 1, 2023, states can begin to disenroll recipients who are no longer eligible. Although a gradual “unwinding” will be in place to minimize disruptions, millions of people are expected to lose coverage. These changes could trigger a qualifying event for some employees.

Health Savings Accounts

Plan sponsors may need to seek guidance from the IRS about pre-deductible coverage for COVID-19 testing and treatments that were allowed during the PHE under HSA-eligible high-deductible plans. The IRS has not indicated if or when this policy might end. Pre-deductible coverage for telehealth services has been approved through the end of 2024.

This is a particularly challenging time for benefit administrators. If you are struggling to keep up with ongoing changes and the complexity of administering benefits, Travisoft can help.