On April 10, 2023, President Joe Biden signed legislation immediately ending the COVID-19 National Emergency. This does not impact the Public Health Emergency, which expired May 11, 2023.
National Emergency Relief – Background
On May 4, 2020, in response to the COVID-19 National Emergency, federal agencies issued a “Notification of Extensions of Certain Timeframes for Employee Benefit Plans, Participants, and Beneficiaries Affected by the COVID-19 Outbreak”. The emergency relief provided extensions for certain time periods and dates (e.g., HIPAA special enrollment, COBRA continuation coverage, and internal claims and appeals).
The “outbreak period” began March 1, 2020 and continues until 60 days after the COVID-19 National Emergency ends, or such other date as the federal government announces.
Based on informal comments from the U.S. Department of Labor (“DOL”), it appears that the extension of benefit plan deadlines will end on July 10, 2023, notwithstanding the legislation ending the COVID-19 National Emergency was signed on April 10, 2023. Although the April 10th termination of the National Emergency technically means that under the current rule, the outbreak period would end a month earlier (on June 9th), it appears that the federal agencies are contemplating changing the rule so that the outbreak period will end on July 10 as previously scheduled. References to July 10 herein are based on anticipation that the July 10 end date will be formalized by the DOL. We will provide an update to this date if the DOL issues a formal announcement indicating otherwise.
The National Emergency extended the deadlines for the following that affected deadlines under the ADP TotalSource, Inc. Health and Welfare Plan (the “Plan”):
- The deadline for a participant to elect COBRA coverage;
- The 60-day period to notify the Plan of a COBRA qualifying event or disability determination;
- The deadline for a participant to pay initial and monthly premiums for COBRA coverage;
- The deadline for providing a COBRA election notice;
- The 60-day period to exercise HIPAA Special Enrollment right to make permitted plan election change mid-plan year;
- The 60-day period to enroll in the medical option under the Plan for those who lose coverage under a state Children’s Health Insurance Program or Medicaid or who are eligible to receive premium assistance under those programs; and
- The extension to file claims and request appeals for adverse claim decisions under ERISA.
How the End of the National Emergency Impacts You
The end of the National Emergency eliminates the mandated extension of deadlines for the above noted events.
Following the last day of the “outbreak period” (July 10, 2023), the deadlines for COBRA, HIPAA Special Enrollment and ERISA claims will return to the normal required timelines prior to the COVID-19 National Emergency.
Extension relief is not provided for any of the above-named events that occur after the outbreak period (July 10, 2023). If the event occurs prior to the outbreak period, the normal required timelines are applicable beginning the day after the end of the outbreak period (July 10, 2023).
Please refer to the ADP TotalSource, Inc. Health and Welfare Plan Summary Plan Description for full details on Plan deadlines for COBRA, HIPAA Special Enrollment and ERISA claims filing and appeals.
Example 1 – HIPAA Special Enrollment Period
Facts: Employee A is eligible for, but previously declined participation in, her employer-sponsored group health plan and the “outbreak period” ended on July 10, 2023. On April 1, 2023, Employee A gave birth and would like to enroll herself and the child in her employer’s plan. However, open enrollment does not begin until June 1, 2023.
When may Employee A exercise her special enrollment rights?
Conclusion: Employee A and her child qualify for HIPAA special enrollment in her employer’s plan as early as the date of the child’s birth, April 1, 2023. Employee A can exercise her HIPAA special enrollment rights for herself and her child until 60 days after July 10, 2023 (the end of the Outbreak Period), which is August 9, 2023, provided she pays the retroactive costs for the period of coverage after the birth.
In this same scenario, if Employee A gives birth after July 10, 2023 (the end of the Outbreak Period) she can exercise her HIPAA special enrollment rights until 60 days after the child’s birth.
Example 2 – Electing COBRA
Facts: Employee B participates in his employer’s group health plan. Employee B experiences a qualifying event for COBRA purposes and loses coverage on July 12, 2023. Employee B is eligible to elect COBRA coverage under his employer’s group health plan and is provided a COBRA election notice on July 15, 2023.
What is the deadline for Employee B to elect COBRA?
Conclusion: Because the qualifying event occurred on July 12, 2023, after the end of both the COVID-19 National Emergency and the Outbreak Period, the extensions under the emergency relief notices do not apply. The last day of Employee B’s COBRA election period is 60 days after July 15, 2023, which is September 13, 2023.
When does the extension to file Healthcare FSA claims end?
Since the National Emergency has ended, the extension to file Healthcare FSA claims will end after the Outbreak Period (July 10, 2023). This means for eligible Healthcare FSA and Limited Healthcare FSA claims incurred in the 2021-2022 Plan year, the filing extension period will end on July 10, 2023, the end of the outbreak period.
For eligible Healthcare FSA and Limited Healthcare FSA claims incurred in the current Plan year (2022-2023), the deadline to file such claims is July 30, 2023 and there is no extension beyond that date.
How the End of the Public Health Emergency (PHE) Impacts Your Health Benefits
In January 2020 as a result of the COVID-19 pandemic, the U.S. Department of Health and Human Services (HHS) declared a Public Health Emergency (“PHE”) mandating that health insurance carriers provide access to no-cost COVID-19 tests, 8 free at-home COVID tests per month, and no-cost COVID vaccines obtained whether in- or out-of-network.
The PHE is set to expire on May 11, 2023. Starting May 12, 2023, health insurance carriers will no longer be subject to federal requirements for coverage of COVID-19 testing, vaccinations and treatments. Please note this change may also affect the out-of-pocket expenses a health plan participant may incur for certain services.
Please refer to your health insurance carrier’s member website or customer service assistance line for specific questions you may have regarding coverage levels associated with the end of the Public Health Emergency.
The End of the Public Health Emergency (PHE) Impact on Medicaid and CHIP & Your Options
During the PHE, certain states allowed continuous Medicaid and Children’s Health Insurance Plan (“CHIP”) enrollment without requiring annual renewal – also called “redetermination” or “recertification”. Beginning April 1, 2023 the annual redeterminations may start again which may result in your or your dependent’s loss of Medicaid or CHIP coverage. Please contact the applicable state agency if you have any questions about your Medicaid or CHIP enrollments.
Your Options if You Lose Medicaid or CHIP Coverage
The loss of Medicaid or CHIP is a HIPAA special enrollment right. If you or your dependents no longer qualify for either Medicaid or CHIP and your coverage is terminated, you may elect to enroll in coverage through the ADP TotalSource, Inc. Health and Welfare Plan, if you are otherwise eligible for coverage under the Plan.
You will have 60 days from your loss of Medicaid or CHIP coverage to notify ADP TotalSource and request coverage along with your loss of coverage proof (in the form of a termination of coverage notice). Your coverage election change with ADP TotalSource will be effective prospectively on the first (1st) of the month following completion of your notification request including receipt of supporting documentation.
Please do not delay in submitting your request for HIPAA Special Enrollment, if applicable, to avoid any gaps in coverage. Note HIPAA special enrollment events are restricted to medical coverage changes only.
If your Medicaid or CHIP coverage is terminated:
- before the end of the National Emergency Outbreak Period (July 10, 2023) you will have an extended period to notify ADP TotalSource of your loss of coverage until September 8, 2023 (i.e., 60 days following the end of the National Emergency outbreak period).
- after the Outbreak Period ends (July 10, 2023), you must notify ADP TotalSource of your loss of coverage and provide supporting documentation within 60 days from the date Medicaid or CHIP coverage is terminated.
Example 1 – Loss of Medicaid or CHIP Before the End of the Outbreak Period– HIPAA Special Enrollment
Facts: Employee C is eligible for, but previously declined participation in, her employer-sponsored group health plan. On April 27, 2023, Employee C was notified of her loss of Medicaid coverage and would like to enroll herself in her employer’s plan. However, open enrollment does not begin until June 1, 2023.
When may Employee C exercise her special enrollment rights?
Conclusion: Employee C qualifies for HIPAA special enrollment in her employer’s plan due to her loss of Medicaid coverage. Employee C can exercise her HIPAA special enrollment rights until 60 days after July 10, 2023 (the end of the Outbreak Period), which is September 8, 2023.
Example 2 – Loss of Medicaid or CHIP After the End of the Outbreak Period– HIPAA Special Enrollment
Facts: Same as above except Employee C experiences loss of Medicaid on July 15, 2023.
When may Employee C exercise her special enrollment rights?
Conclusion: Employee C can exercise her HIPAA special enrollment rights until 60 days after July 15, 2023, her date of Medicaid loss of coverage.
Other Coverage Options if You or Your Dependents Lose Medicaid or CHIP
If you or your dependents lose your Medicaid or CHIP coverage, you may be eligible to purchase health plan coverage through the Health Insurance Marketplace. Loss of these coverages may qualify you for a special enrollment event. Visit www.healthcare.gov for further details.
Dental allowances are structured on Calendar Year (resets Jan. 1) and vision allowances with VSP go by Plan Year (resets June 1).
