In January 2023, President Joe Biden announced that the U.S. government plans to end national and public health emergency declarations on May 11, 2023. These declarations were implemented at the beginning of the COVID-19 pandemic as temporary relief measures. The United States government vowed to give at least a 60-day warning not to cause panic or chaos.
Changes Related to Public Health
The Public Health Emergency was first declared by the U.S. Secretary of the Department of Health and Human Services in January 2020. It has been continuously renewed every 90 days since. That is, until the recent announcement.
Changes to the PHE will have an impact on health plan coverage rules:
Diagnostic Testing – Once the PHE was declared, health plans and insurers had to cover COVID-19 tests and other related services without implementing cost-sharing or medical management requirements. Health plans and insurers will not be required to provide first-dollar coverage when the PHE concludes. First-dollar coverage excludes insured parties from paying copays or out-of-pocket expenses before coverage begins.
Insurance Providers – During the PHE, non-grandfathered group health plans and health insurance providers had to cover COVID-19 preventive services, including vaccine shots, without cost-sharing requirements. With the PHE concluding, health plans will still be required to offer COVID-19 vaccine shots without cost sharing, however, they can now limit this service to in-network providers.
Telehealth Services – Certain telehealth benefits will no longer be available once the PHE ends. It currently allows employers with more than 50 employees to offer telehealth benefits to people who do not qualify for coverage under any other group health plan that the employer offers. This allowance will no longer be permitted after the PHE.
Take Note of These Deadline Extension Changes
In 2020, President Donald Trump put the national emergency declaration in place as it is allowed by the National Emergencies Act. A national emergency remains in place until a president terminates it. Congress can also pass a joint resolution to end a national emergency declaration.
The end of the national emergency declaration will impact certain deadline extensions. This will impact important employee benefit plans:
HIPAA Special Enrollment – A 30 or 60-day period to request special enrollment.
COBRA Deadlines – The 60-day period to choose COBRA coverage, the date for making premium payments, and the date for individuals to notify the plan of a qualifying event or disability determination.
Claims and Appeals Deadlines – The deadlines to file a benefits claim, file an appeal for an adverse benefit determination, or request an external review of a claim under the plan’s claims and appeals procedures.
All of these deadline extensions will end on July 10th, 2023. This date marks the end of the outbreak period.
What Are the Next Steps Employers Should Take?
Employers need to take several steps to ensure they are prepared for the changes that will go into effect this summer.
- Employer sponsors should contact insurers and third-party administrators to become aware of any changes to their coverage. If employer sponsors are subject to the Employee Retirement Income Security Act of 1974 or ERISA, changes have to be shared with participants with a summary of material modification or revised summary plan description within 60 days after the adoption of the change.
- Distribute a summary of benefits and coverage plan to participants if changes are made due to the conclusion of the PHE if the changes impact the wording of the summary of benefits and coverage plan. Send the new plan to participants 60 days before any plan modifications are made.
- Employer sponsors that offered stand-alone telemedicine services or an employee assistance program that covered the cost of COVID-19 testing or vaccines will have to amend or terminate these services.
- Employer sponsors need to review current COBRA notices and contact their COBRA vendor to remove any wording that was added regarding the approaching deadlines.
- Check-in with COBRA vendors, third-party administrators, and claims administrators that the process for notifying plan participants that pre-national emergency deadlines will continue after July 10th, 2023.
- Change any plan documents or summary plan descriptions that had language related to extending any deadlines during the national emergency period.
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