Although the COVID-19 pandemic continues to move into the next phase and even appears to be receding into the rearview mirror for many, COVID-related requirements continued in earnest throughout 2022. This includes several extensions of the COVID-19 Public Health Emergency (PHE), the last one of 2022 announced on October 13, 2022, and scheduled to expire on January 11, 2023.
As expected, on January 11, 2023, U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra renewed the determination that a COVID-19 PHE exists for an additional 90 days, through April 11, 2023.
This is the 12th renewal of the COVID-19 PHE determination, initially declared by the HHS Secretary on January 31, 2020.
White House officials confirmed they are targeting to end the COVID-19 PHE as soon as the spring, meaning this most recent PHE extension announcement on January 11, 2023, could be the final COVID-19 PHE. HHS will provide a 60-day notice before any possible termination or expiration of the PHE determination.
PHE Benefit Plan Distinctions
This most recent renewal of the COVID-19 PHE permits group health plans and insurers to continue relying on the flexibilities[1] instituted by the federal government, including the following benefit plan items still in effect:
- COVID-19 Tests and Treatment: Group health plans are required to cover all COVID-19 tests (including over-the-counter tests) as well as related treatment services and visits, all without participant cost-sharing.
- COVID-19 Vaccines: Group health plans are required to cover COVID-19 vaccines, including booster shots, without participant cost-sharing. As a reminder, the COVID-19 PHE requires group health plans to cover the cost of administering COVID-19 vaccines and booster shots as a covered preventive service. However, the actual cost of the vaccine itself is paid for by the federal government under the PHE.
- Excepted Benefits and COVID-19 Testing: Employers can offer COVID-19 testing and vaccine coverage through an employee assistance plan (EAP) or an onsite medical clinic without the EAP or the onsite clinic offering “significant” medical care. As a result, these EAPs and onsite clinics can maintain their “excepted” benefit status and will not be subject to various laws that would otherwise apply to group health plans.
- Telehealth and Remote Care Services: Large employers (those with at least 51 employees) may offer access to telehealth and remote care services on a standalone basis for employees (and dependents) not otherwise eligible for the employer-sponsored group health plan.
- Grandfathered plans: Grandfathered plans that changed certain benefits related to COVID-19, such as the addition of a telehealth benefit or elimination/reduction of cost-sharing, will not lose grandfathered status even if these benefit changes revert back once the PHE expires.
- SBC Changes: The 60-day advance notice requirement for certain changes to a summary of benefits and coverage (SBC) is temporarily waived under the PHE.
COVID-19 National Emergency
The COVID-19 PHE declaration is separate from, and should not be confused with, the COVID-19 National Emergency declared by the President, which impacts the end of the “outbreak period” (which began on March 1, 2020) for deadlines related to COBRA election and payment rules, HIPAA special enrollment as well as other benefit plan deadlines. The most recent National Emergency was extended in February 2022 and is currently set to expire in March 2023. Additional information on the extension’s impact on COBRA deadlines can be found here.
Next Steps for Employers
Employers should continue to comply with the required COVID-19 PHE benefit plan items, as applicable, outlined above. Employers may also begin considering preparations to wind down these items, in collaboration with their group health plans' carriers, third-party administrators, and/or pharmacy benefit managers, once the COVID-19 PHE expires. These preparations would include clear communications to employees. As mentioned above, the COVID-19 PHE is expected to expire later this spring.
Reach out to your Risk Strategies representative with any questions or contact us directly at benefits@risk-strategies.com.
[1] FAQs About Families First Coronavirus Response Act and Coronavirus Aid, Relief, and Economic Security Act Implementation Part 42, Part 43 and Part 44.
