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)
The Department of Health and Human Services (HHS) first declared the PHE in January 2020. PHE declarations last for 90 days unless an extension is granted. Since January 2020, the PHE has been renewed every 90 days. Most recently, the PHE has been extended until January 11, 2023. 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.
Should the PHE be allowed to expire, HHS must provide states with at least 60 days’ advance notice, so unless HHS provides such notice before mid-November, it is reasonable to assume it will be extended again.
The COVID-19 National Emergency
The COVID-19 National Emergency is declared by the President and the declarations last for one-year unless an extension is granted. On March 13, 2020, the COVID-19 National Emergency was announced, and it has been extended every year since. Currently, the COVID-19 National Emergency is set to expire on March 1, 2023.
The COVID-19 National Emergency introduced to 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.
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.
Next Steps for Employers
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.
HR Works will continue to monitor this topic and provide updates as they become available.