QUESTION: As a result of COVID-19 emergency, we have now been required to increase deadlines for contributors and beneficiaries to submit claims and appeals underneath our worker profit plans. How does the top of the COVID-19 nationwide emergency have an effect on these extensions?

ANSWER: Numerous plan-related deadlines have been prolonged—however for not than one yr—by disregarding (tolling) the COVID-19 “outbreak interval,” which ends 60 days after the top of the nationwide emergency until one other finish date is introduced by the companies (see our Checkpoint article). The COVID-19 nationwide emergency ended on April 10, 2023 (see our Checkpoint article). Though 60 days later could be June 9, 2023, the DOL has informally commented that, in line with FAQs issued in March 2023 (see our Checkpoint article), the outbreak interval will finish on July 10, 2023.

The outbreak interval aid extends the deadlines for people to file claims for advantages and appeals of hostile profit determinations underneath worker profit plans which are topic to ERISA or the Code—together with group well being plans, incapacity and different worker welfare profit plans, and retirement plans. For group well being plans, the extension additionally applies to deadlines for requesting exterior assessment following exhaustion of the plan’s inside appeals procedures and for perfecting an incomplete request for assessment. The disregarded interval lasts till the sooner of (1) one yr from the date the person was first eligible for outbreak interval aid, or (2) the top of the outbreak interval. As soon as the disregarded interval has ended, the common timeframes resume. Thus, the prolonged deadline have to be decided on a person foundation. For instance:

Alex, a participant in a gaggle well being plan that usually requires claims to be submitted inside one yr after the date of service, acquired medical care on July 1, 2022. The disregarded interval begins on the service date (July 1, 2022) and ends on the sooner of 1 yr later (July 1, 2023) or the top of the outbreak interval (July 10, 2023). Thus, the plan’s common one-year timeline begins to run on July 1, 2023, so the deadline for Alex to submit a declare is July 1, 2024. For medical care acquired on August 1, 2022, the disregarded interval would finish on July 10, 2023 (the sooner of the top of the outbreak interval or one yr after the service date), after which the plan’s common one-year timeline would start to run, so the deadline for submitting a declare could be July 10, 2024.

Notice {that a} completely different interpretation of the extension—making use of the plan’s timeline first and the outbreak interval aid after the top of the common timeline—would produce a special end in some circumstances. Making use of this interpretation to the primary instance above, the declare submission deadline could be July 10, 2023 (the sooner of July 10, 2023, or one yr after the July 1, 2023, common declare submission deadline). On condition that the companies, within the FAQs, inspired plans to permit contributors and beneficiaries extra time to behave, it appears advisable to take the strategy that leads to the later deadline. In any occasion, clear communication and consistency in utility shall be essential.

Though plans weren’t expressly granted extra time to course of and determine claims, the DOL acknowledged that the COVID-19 emergency could current challenges in attaining “full and well timed compliance” with ERISA’s claims process necessities and mentioned that its strategy to enforcement would emphasize compliance help. However at this late stage of the pandemic, it appears unlikely that the DOL would grant plans a lot leeway on this regard.

For extra data, see EBIA’s ERISA Compliance handbook at Sections XXXIV.F (“Timelines Beneath Group Well being Claims Procedures”), XXXIV.M (“Exterior Overview Necessities”), and XXXV.E (“Timelines for Incapacity and Different Non-Well being Choices”). See additionally EBIA’s Well being Care Reform handbook at Part XV (“Appeals Course of and Exterior Overview Necessities”), EBIA’s Self-Insured Well being Plans handbook at Part XXVI (“Claims and Appeals”), EBIA’s Cafeteria Plans handbook at Part XVI.N (“Momentary COVID-19-Associated Aid for Cafeteria Plans, Well being FSAs, and DCAPs”), and EBIA’s 401(ok) Plans handbook at Part XXX.D (“Preliminary Profit Determinations”).

Contributing Editors: EBIA Workers.