On March 13, 2020, the Proclamation on Declaring a National Emergency Concerning the Novel Coronavirus Disease (COVID-19) Outbreak was issued by President Trump. As a result of the National Emergency, participants and beneficiaries covered by group health plans, disability or other employee welfare benefit plans, and employee pension benefit plans have faced several challenges. Therefore, the Agencies, including Health and Human Services (HHS), DOL and IRS, had to take action to reduce the possibility of individuals losing benefits due to noncompliance with certain pre-established timeframes.
The Agencies have extended certain timeframes in order to preserve and protect the benefits of participants and beneficiaries in all employee benefit plans across the United States during the National Emergency. Similarly, the HHS has also agreed to provide an extension of timeframes otherwise applicable to non-Federal governmental group health plans and health insurance issuers offering coverage in connection with a group health plan, and their participants, beneficiaries and enrollees under applicable provisions of the Public Health Service Act (PHS Act). Accordingly, plan sponsors of non-Federal governmental group health plans are encouraged to provide similar aid, as well as state and health insurance issuers to enforce and operate in a manner consistent with the relief.
With that in mind, the provided relief is as follows: all group health plans, disability and other employee welfare benefit plans, and employee pension benefit plans subject to ERISA or the Code must disregard the period from March 1, 2020 until sixty (60) days after the announced end of the National Emergency or such other date announced by the Agencies in a future notice (the “Outbreak Period”) for all plan participants, beneficiaries, qualified beneficiaries, or claimants wherever located in determining the following periods and dates.
- The 30-day period (or 60-day period, if applicable) to request special enrollment under HIPAA,
- The 60-day election period for COBRA continuation coverage,
- The date for making COBRA premium payments,
- The date for individuals to notify the plan of a qualifying event or determination of disability under ERISA,
- The date within which individuals may file a benefit claim under the plan’s claims procedures,
- The date within which claimants may file an appeal of an adverse benefit determination,
- The date within which claimants may file a request for an external review after receipt of an adverse benefit determination or final internal adverse benefit determination, and
- The date within which a claimant may file information to perfect a request for external review upon a finding that the request was not complete.
The Outbreak Period should be disregarded when determining the date for providing a COBRA election notice. Additional relief may be provided as needed by the Agencies. The examples to follow are set with an assumed end date for the National Emergency in order to make them clear and easy to understand. With an assumed end date of the National Emergency being April 30, 2020, the Outbreak Period would end on June 29,2020 (60 days after the end of the National Emergency). To the extent there are different Outbreak Period end dates for different parts of the country, the Agencies will issue additional guidance regarding the application of the relief in this notice.
Example 1: Electing COBRA
Individual A works for Employer X and participates in X’s group health plan. Due to the National Emergency, Individual A experiences a qualifying event for COBRA purposes as a result of a reduction of hours below the hours necessary to meet the group health plan’s eligibility requirements and has no other coverage. Individual A is provided a COBRA election notice on April 1, 2020. What is the deadline for A to elect COBRA?
Conclusion: In Example 1, Individual A is eligible to elect COBRA coverage under Employer X’s plan. The Outbreak Period is disregarded for purposes of determining Individual A’s COBRA election period. The last day of Individual A’s COBRA election period is 60 days after June 29, 2020, which is August 28, 2020.
Example 2: Special enrollment period
Individual B is eligible for, but previously declined participation in, her employer-sponsored group health plan. On March 31, 2020, Individual B gave birth and would like to enroll herself and the child into her employer’s plan; however, open enrollment does not begin until November 15. When may Individual B exercise her special enrollment rights?
Conclusion: In Example 2, the Outbreak Period is disregarded for purposes of determining Individual B’s special enrollment period. Individual B and her child qualify for special enrollment into her employer’s plan as early as the date of the child’s birth. Individual B may exercise her special enrollment rights for herself and her child into her employer’s plan until 30 days after June 29, 2020, which is July 29, 2020, provided that she pays the premiums for any period of coverage.
Employers should make sure they are adhering to the extended deadlines provided. We will continue to monitor additional relief efforts and will be updating our Coronavirus Resource Page as changes occur. If there are any questions, please contact an Assurance Representative.