The DOL, HHS, and IRS have collectively issued FAQs addressing how group well being plans and insurers might be impacted by the top of the COVID-19 nationwide emergency (NE) and public well being emergency (PHE). This text highlights FAQs addressing the top of the NE, in addition to particular enrollment points regarding lack of eligibility for Medicaid and Kids’s Well being Insurance coverage Program (CHIP) protection. FAQs addressing the top of the PHE are coated individually (see our Checkpoint article).

In the course of the COVID-19 emergency, numerous plan-related deadlines had been prolonged by disregarding (for a most of 1 12 months) the “outbreak interval,” which is able to finish 60 days after the top of the NE until one other finish date is introduced by the businesses (see our Checkpoint article). Primarily based on the Biden administration’s announcement that the NE and PHE will finish on Might 11, 2023 (see our Checkpoint article), the businesses anticipate that the outbreak interval will finish July 10, 2023, though Congress has since voted to finish the NE sooner, which may end in an earlier finish to the outbreak interval. After the top of the outbreak interval, extensions will not be required, however the businesses encourage group well being plans to permit for longer timeframes, noting that nothing within the Code or ERISA prevents this.

Examples illustrate how the outbreak interval’s finish (assumed to be July 10, 2023) impacts COBRA elections and premium funds and HIPAA particular enrollment deadlines:

• Electing COBRA. If a participant experiences a qualifying occasion and is offered a COBRA election discover earlier than the top of the outbreak interval, the person’s 60-day interval to elect COBRA begins to run on July 10, 2023 (making the deadline September 8, 2023)—no matter whether or not the qualifying occasion, lack of protection, or provision of the COBRA discover happens earlier than or after the top of the NE. If the qualifying occasion happens after the top of the outbreak interval, there isn’t a extension, and the 60-day interval is measured from the date the COBRA election discover is offered. [EBIA Comment: Although not expressly addressed in the FAQs, it appears that if a qualifying event occurs before the end of the outbreak period and the COBRA election notice is provided after the end of the outbreak period, the COBRA election deadline would be measured from provision of the notice.]

• Paying COBRA Premiums. The FAQs present an instance of a COBRA election made on October 15, 2022, retroactive to October 1, 2022. The preliminary COBRA fee, overlaying premiums from October 2022 via July 2023, should be made no later than 45 days after the top of the outbreak interval (i.e., August 24, 2023), with subsequent funds due in line with the common COBRA timeline (the primary day of every month of protection, with a 30-day grace interval).

• HIPAA Particular Enrollment. For occasions giving rise to HIPAA particular enrollment rights that happen earlier than the top of the outbreak interval, the relevant particular enrollment interval begins to run on July 10, 2023. Within the examples, a person who offers delivery to a toddler earlier than the top of the outbreak interval has till August 9, 2023 (30 days after the top of the outbreak interval) to train particular enrollment rights, no matter whether or not the delivery occurred earlier than or after the top of the NE. A person who offers delivery after the top of the outbreak interval has 30 days after the date of the delivery to train particular enrollment rights.

The FAQs additionally clarify that state businesses typically haven’t terminated people’ Medicaid or CHIP protection over the last three years, however that program eligibility determinations will resume after this “steady enrollment situation” ends on March 31, 2023. Workers who’re eligible for particular enrollment in an employer plan because of dropping Medicaid or CHIP protection from March 31, 2023, via the top of the outbreak interval have till 60 days after the top of the outbreak interval to request plan enrollment. The businesses encourage group well being plans to permit an extended particular enrollment interval, and recommend that employers make sure that their advantages workers are conscious of the Medicaid and CHIP eligibility change. A DOL weblog put up highlights these points, reiterates the suggestion to increase plan deadlines, and recommends that employers talk key deadlines to affected people upfront.

EBIA Remark: The FAQs depart some open questions—notably, no examples deal with how the outbreak interval’s finish will have an effect on prolonged deadlines for submitting profit claims, appeals, and requests for exterior overview; specific steering can be welcomed. In the meantime, plan sponsors, directors, and repair suppliers ought to familiarize themselves with the FAQs in preparation for the top of the NE and PHE. For extra data, see EBIA’s COBRA guide at Part VI.D (“COVID-19: COBRA Election and Premium Cost Deadlines”), EBIA’s HIPAA Portability, Privateness & Safety guide at Part X (“Particular Enrollment Rights”), and EBIA’s Self-Insured Well being Plans guide at Sections XVI.C.4 (“Particular Enrollment Intervals Required Below HIPAA”) and XXVI.E (“Timelines Below Group Well being Plan Claims Procedures”).

Contributing Editors: EBIA Workers.