Due to the COVID-19 pandemic, two separate emergency declarations have remained in effect:
- The COVID-19 National Emergency, and
- The Public Health Emergency (PHE).
These emergency declarations provide different types of COVID-related relief for participants and group health plans.
The Public Health Emergency (PHE)
On January 31, 2020, the Secretary of Health and Human Services (HHS) declared a public health emergency (PHE) in the United States due to the COVID-19 pandemic. The COVID-19 PHE has been extended again on January 11, 2023 until April 11, 2023. PHE declarations last for 90 days unless an extension is granted.
Since the pandemic, the PHE has been extended several times. This extension has implications for employers, and as result of this extension, employers should note that temporary changes for ERISA-governed group health and welfare plans remain in effect and plan sponsors are required to:
- Cover COVID-19 diagnostic testing and related services;
- Cover COVID-19 vaccines, including booster doses from out-of-network providers without cost-sharing, prior authorization, or other medical management requirements; and
- Can continue to offer stand-alone telehealth benefits and other remote care services to participants who are not eligible for major medical coverage.
When the PHE is allowed to expire, HHS must provide states with at least 60 days’ advance notice.
The COVID-19 National Emergency
As a reminder, the COVID-19 National Emergency also remains in effect. Since it was first established on March 13, 2020, it has been extended every year. Currently, it is set to expire on March 1, 2023 unless it is further extended.
The COVID-19 National Emergency introduced the “Outbreak Period” in which certain ERISA-related deadlines were extended to provide relief from COVID-19. The Outbreak Period is the period between March 1, 2020, and the earlier of:
- One year from the date the participant was first eligible for the relief; or
- 60 days after the announced end of the National Emergency.
While the Outbreak Period remains in place, plan sponsors should note that the following relief measures remain in place:
- The 30-day period (or 60-day period, if applicable) to request HIPAA special enrollment.
- The 60-day election period for COBRA continuation coverage.
- The date for making COBRA premium payments.
- The date for individuals to notify the plan of a COBRA qualifying event or new disability.
- The date for plan sponsors and administrators to provide a COBRA election notice (typically within 14 days after the plan receives notice of a qualifying event).
- The date within which individuals may file a benefit claim under a plan’s claims procedures.
- The deadlines for requesting internal and external appeals for adverse benefits determinations.
Next Steps for Employers
Notably, on January 30, 2023, President Joe Biden informed Congress that he will end the twin national emergencies for addressing COVID-19 on May 11. Until this time, plan sponsors should continue to cover COVID-19 testing and out-of-network vaccines without cost-sharing, prior authorization, or other medical management requirements. Of note, plan sponsors will still be required to cover COVID-19 vaccines from in-network providers at no cost as a preventive service.
In regard to the Outbreak Period, employers must be mindful that not every participant and beneficiary’s deadline will be on the same date and consider sending communications to those whose deadlines are approaching.
The Outbreak Period continues until the President terminates it or does not issue an annual continuation notice, or a joint resolution of Congress terminates it.
HR Works will continue to monitor this topic and provide updates as they become available.