Two Areas Impacting Benefits When the COVID-19 Emergencies End | FAIRMOUNT BENEFITS

When the COVID-19 public health emergency and national emergency were declared in 2020, no one anticipated they would still be in place in 2023.

On January 30, 2023, the President announced the intent to end the emergencies on May 11, 2023. The impact of the emergencies on employer-sponsored benefits affected certain coverages, reimbursements, and timelines. Multiple laws and regulations passed after 2020 created temporary rules tied to the end of the emergencies. As a result, employers will face significant tasks and obligations to unwind the changes from the last three years.

There are two areas of significance for employers: free coverages that will end, and required deadlines that will begin. Here’s what you need to keep in mind for each:

1. Free coverages that will end

The Families First Coronavirus Response Act (FFCRA) required health plans to cover the cost of COVID-19 testing and related services with no cost-sharing. The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) expanded the FFCRA by adding over-the-counter tests and vaccinations by out-of-network providers.

When the emergency ends, this required no-cost coverage of testing and related services will sunset. Employers with fully insured plans should speak with their carrier to discuss whether there will be any option to continue the coverage with no cost-sharing. Each state’s Department of Insurance should provide guidance to carriers on when cost-sharing will resume. Self-funded groups may have more flexibility to continue to offer testing and related services with no-cost sharing. Due to the Affordable Care Act’s preventative services requirement, fully approved COVID-19 vaccines will remain covered, without cost, by in-network providers. A reduction in coverage will require a 60-day advance notice to affected employees.

Another specific impact is stand-alone telehealth benefits. Employees who were ineligible for their employer’s health plan were permitted to enroll in stand-alone telehealth benefits. The relief applies for the plan year that begins on or before the end of the emergency. An employer providing stand-alone telehealth will not be able to continue the coverage past the end of the current plan year and should review their policy to modify the language for stand-alone coverage. A reduction in coverage requires sending a notice to affected employees 60 days prior to the plan year end date.

2. Required deadlines that will begin

Many provisions of the last three years are tied to outbreak period rules issued in May 2020. The outbreak period lasts until 60 days after the end of the national emergency. These rules extended several key deadlines related to COBRA, special enrollment periods, claim submission, and appeal processes.

The Employee Benefits Services Administration issued a notice in 2021 providing guidance and clarity for employers, stating that the maximum period a deadline may extend is the earlier of one year from the date an original deadline would begin, or 60 days after the end of the outbreak period. This one-year period is known as tolling.

The challenge for employers will be tracking each individual’s tolling period as the end of the outbreak period nears. For example, an employee traditionally has 60 days to elect COBRA continuation coverage. The 60-day deadline would not begin until one year and 60 days later or 60 days after the outbreak period.

To illustrate this, imagine this scenario:

  • Employee A’s benefits were terminated on December 31, 2022.
  • Traditionally, they would have until March 2023 to elect COBRA.
  • The relief states the 60-day countdown would not begin until the earlier of one year (December 2023) or July 10, 2023 (60 days after the end of the outbreak period).
  • Since the outbreak period end date is planned for May 11, 2023, which is earlier than the one-year tolling, Employee A must make their COBRA election by September 20, 2023.

The tolling period has been a point of confusion for employers and may be more confusing as the outbreak period now has a planned end date of May 11, 2023.

The Department of Health and Human Services (HHS) provided a roadmap on February 9, 2022, outlining what may and may not be affected by the end of the emergencies. HHS also indicated it will continue “to review the flexibilities and policies implemented during the COVID-19 PHE to determine whether others can and should remain in place, even for a temporary duration, to facilitate jurisdictions’ ability to provide care and resources to Americans.”

Employers and plan sponsors should continue monitoring federal and state government resources. Employers may need to revise plan documents and provide new notifications to employees when coverage is changed or eliminated.

Originally posted on Mineral



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