The COVID-19 public health emergency and national emergency are set to come to an end after the Administration released a statement on January 30, 2023. The administration decided to extend both emergency declarations until a new ending date of May 11, 2023 which aligns with the administration’s promise of allowing at least a 60-day notice to the end of the public health emergency. While both emergency declarations will be ending on the same date, they are separate and tied to different requirements.
For group health plans, the end of the public health emergency signifies the end of required coverage of COVID-19 diagnosis/testing (prescribed and OTC) and the out-of-network COVID-19 vaccination at no cost to participants. Employers will now have to decide how they would like to continue coverage for these items. Please note, the COVID vaccination has been added to the CDC’s immunization schedule so it will still be required to be payable at no cost share to participants at the In-Network level. When the vaccine is obtained out-of-network, the plan can now require cost-sharing like all other preventive benefits. As for COVID-19 diagnosis/testing (prescribed and OTC), the plan will no longer be required to cover this service at no cost share to the member. We anticipate plans will want to pay for COVID-19 diagnosis/testing the same as any other illness (i.e. flu, strep, etc.), but will verify that with each plan individually over the coming weeks. Please be anticipating your plan document specialist to reach out to you with further information.
The end of the national emergency signifies the ending of the “Outbreak Period” which allowed for numerous timeframe extensions for many of your plan’s provisions. Since 2020, the normal plan deadlines for the following items were to be disregarded until the earlier of one year from the date they were first eligible for relief or sixty (60) days after the announced end of the national emergency at which point the normal plan deadlines may resume. The plan provisions subject to these extensions are:
- HIPAA Special Enrollment;
- COBRA election period;
- Deadline to furnish the COBRA election notice;
- Date for making COBRA premium payments;
- Claim filing deadlines;
- The date a participant must notify the plan of a qualifying event or determination of disability;
- The date in which the participant may file an appeal of an adverse benefit determination;
- The date in which the participant may request an external review after an adverse benefit determination or final internal adverse benefit determination; and
- The date in which a participant may file information to perfect a request for external review upon finding that the initial request was not complete.
Since the national emergency will be ending on May 11, 2023, the tolling period will come to an end on July 10, 2023 (60 days following the end of the Outbreak Period). To determine when to begin calculating your normal plan deadlines, the following will be your easy-to-apply rule:
- If any of the above events took place prior to July 10, 2022, the one-year mark would have passed and calculation of the normal plan deadline should have already begun.
- If any of the above events took place on or after July 10, 2022, calculation of the normal plan deadlines should begin on July 10, 2023.
The above summary should not be taken as legal advice.