In line with the COVID-19 pandemic becoming endemic and moving into its next phase, on January 30, 2023 the White House Office of Management and Budget announced its plan to extend both the COVID-19 Public Health Emergency and COVID-19 National Emergency declarations until May 11, 2023, and then terminate both declarations on that date. This article focuses on the upcoming impacts this announcement will have on employers sponsoring group health plans.
COVID-19 Public Health Emergency
We just reported on the most recent extension of the COVID-19 Public Health Emergency (PHE) on January 11, 2023, which was scheduled to expire on April 11, 2023. This was the 12th renewal of the COVID-19 PHE determination, initially declared by the HHS Secretary on January 31, 2020.
Since the U.S. Department of Health and Human Services (HHS) previously confirmed they will provide a 60-day notice before any possible termination of the PHE determination, this most recent announcement comes before that February 11, 2023 deadline (60 days before April 11, 2023) and extends the COVID-19 PHE for an additional month until May 11, 2023.
The planned end of the COVID-19 PHE on May 11, 2023 will result in the termination of the following COVID-19 PHE benefit plan flexibilities and enhancements:
- COVID-19 Tests and Treatment: Group health plans will not be required to cover COVID-19 tests (including over-the-counter tests), as well as related treatment services and visits, without participant cost-sharing. As a reminder, group health plans have been required since January 15, 2022 to cover over-the-counter COVID tests at no cost to covered individuals. Once the COVID-19 PHE ends, group health plans may, but are not required to, provide this first dollar coverage for COVID tests and related treatment.
- COVID-19 Vaccines: Group health plans will still be required to cover COVID-19 vaccines, including booster shots, without participant cost-sharing, but can limit this coverage to only in-network providers. During the COVID-19 PHE, group health plans must cover COVID-19 vaccines and booster shots, provided by both in-network and out-of-network providers, as a covered preventive service.
- Excepted Benefits and COVID-19 Testing: Employers may not continue to 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 cannot maintain their “excepted” benefit status and may 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 not continue to 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: Unlike the items listed above, 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 COVID-19 PHE expires.
COVID-19 National Emergency
The COVID-19 National Emergency, first declared on March 1, 2020 and extended again on February 24, 2021 and on February 18, 2022, impacts various group health plan-related deadlines, including certain COBRA-related deadlines. Click here for a prior Risk Strategies article highlighting these deadlines.
National Emergency declarations generally last for one year or 60 days from the announced end of the National Emergency, if earlier.
Now that the White House announced its intention to terminate the National Emergency declaration on May 11, 2023 as well, the following COBRA-related and other plan deadline extensions are scheduled to expire on July 10, 2023 (60 days after May 11, 2023) and revert back to their standard statutory/regulatory deadlines:
- COBRA Election Notice: Standard 14-day deadline (or 44 days if the employer is the plan administrator) for plan administrators to distribute a COBRA election notice to qualified beneficiaries.
- COBRA Election Period: Standard 60-day deadline for qualified COBRA beneficiaries to elect COBRA coverage.
- COBRA Premium Payments: Standard 45-day (for the initial payment) and 30-day (for subsequent payments) deadlines for qualified COBRA beneficiaries to pay COBRA premiums in a timely manner.
- COBRA Qualifying Event: Standard 60-day deadline in which qualified COBRA beneficiaries must notify the plan of certain qualifying events, such as divorce or legal separation or a dependent child ceasing to be a dependent under the terms of the plan.
- COBRA Disability Extension Notices: Standard 60-day deadline in which qualified COBRA beneficiaries must notify the plan of a disability determination.
- HIPAA Special Enrollment Period: Standard 30-day or 60-day period to submit a HIPAA special enrollment request.
- Claims and Appeals Deadlines: Standard deadlines to file a claim, an appeal of an adverse benefit determination, or a request for an external review of a claim.
Reminder: Telehealth Relief for HSA-Compatible HDHPs Extended For Two More Years
Finally, telehealth relief for HSA-compatible high-deductible health plans, originally passed under the CARES Act of 2020 in response to the COVID-19 pandemic, was recently extended for two more years under federal legislation passed at the end of 2022. Click here to learn more.
Next Steps for Employers
In the immediate short term, employers sponsoring group health plans should continue to comply with the required COVID-19 PHE and National Emergency benefit plan changes and extensions, as applicable, outlined above.
However, now that the White House has provided a planned end date of May 11, 2023 for both COVID-19 Emergency declarations, employers are advised to connect with their group health carriers, third-party administrators, and/or pharmacy benefit managers as well as their COBRA vendors to begin preparations for winding down these temporary plan changes and deadline extensions. These preparations should include clear and robust communications to employees well before May 11th on what plan changes to expect going forward. Further, COBRA enrollment and payment tracking systems should be up-to-date. This is particularly important for employers who must begin enforcing standard COBRA deadlines once again, especially since the COBRA election/payment period end date will not be the same for all individuals.
Risk Strategies is following these developments closely and will provide guidance updates as they become available. Reach out to your Risk Strategies representative with any questions or contact us directly at benefits@risk-strategies.com.
