The Employee Benefits Security Administration (EBSA), IRS, and Department of the Treasury issued a joint announcement on April 28th stating that they are extending a variety of timeframes related to employer sponsored healthcare coverage, portability, and continuation under COBRA.
Generally speaking, these extensions are designed to maximize healthcare accessibility during the ongoing COVID-19 outbreak, continue coverage for as many Americans as possible, and loosen up claims negotiating windows in a way that prevents a processing bottleneck from weakening the system as a whole.
In this post we’ll explore:
- Extensions of employee healthcare deadlines under ERISA Section 518
- A few examples of what the extensions mean for employers
- The meaning of the HHS “measured enforcement period”
ERISA Section 518 Relief
Section 518 of ERISA allows for the extension of certain benefits-related filing and documentation deadlines by up to one year in the event of a presidentially declared national emergency.
With this week’s joint announcement, the government has declared that all employee health plans, disability plans and other employee welfare plans must disregard the period from March 1, 2020 until sixty (60) days after the announced end of the COVID-19 national emergency (“the Outbreak Period”) when determining the following periods and dates:
- The 30-day special enrollment periods for employees
- The 60-day COBRA benefit continuation election
- Dates for making COBRA premium payments
- The date for individuals to notify the provider of a qualifying event or determination of disability
- The date range within which individuals can file benefit claims
- The date by which claimants must file an appeal for an adverse determination
- The date range within which individuals can request an external review of an adverse determination
- The date range within which individuals may file information to perfect an external review of an adverse determination
For employers, this means that your plan administrator can’t count dates occurring during the Outbreak Period against employee deadlines. The spirit of these extensions is extremely employee-friendly, but it’s also HR and administrator-friendly, as it significantly reduces the pressure to process claims and push laid off or furloughed employees through off-boarding as quickly as possible.
To see the full text of the joint announcement’s final rule, click here.
What Will This Look Like in Action?
If an employee has a baby during the Outbreak Period, the child can be brought onto employee healthcare via special enrollment until 30 days after the Outbreak Period ends (90 total days after the announced end of the national emergency).
Similarly, if an employee got married shortly before or during the Outbreak Period, the new spouse’s special enrollment period will last until 30 days after the Outbreak Period ends (90 days total after the announced end of the national emergency).
COBRA Election Example
If an employee has been furloughed to the point where they no longer work enough hours to qualify for employer-sponsored coverage due to the national emergency, their COBRA election period must remain open until 60 days after the Outbreak Period ends (120 total days after the announced end of the national emergency).
COBRA Premium Payments Example
If an employee was receiving COBRA coverage at the beginning of the Outbreak Period, premium payments for COBRA coverage during the Outbreak Period will be considered timely if the payments are made within 30 days of the end of the Outbreak Period (90 days total after the announced end of the national emergency). As long as premiums for all months during the Outbreak Period are paid in a timely manner, the employee is eligible to continue coverage.
Claim Filing Example
If an employee has a 365-day filing window for any claim, that window will not begin for any claims made during the Outbreak Period until the Outbreak Period ends. Similarly, the entire date range of the Outbreak Period should be excluded from claims deadline calculations for care that occurred shortly before the national emergency.
The “Measured Enforcement” Period
The Department of Health & Human Services (HHS) officially concurs with the relief announced by EBSA in the joint statement and is relaxing enforcement for public healthcare, while encouraging states to adopt the spirit of the extensions EBSA is creating for private employer-sponsored programs.
No official end date has been announced for this period.
EBSA’s COVID-19 employee benefits deadline extensions are designed to help as many Americans as possible maintain their access to employer-sponsored healthcare during the coronavirus outbreak. While they’re largely employee-friendly, the extensions also help HR departments and benefits administrators reduce the bottleneck that COVID-19 has created.
- The “Outbreak Period” is defined as March 1, 2020 until 60 days after the COVID-19 national emergency is declared over.
- Dates falling within the Outbreak Period should not be counted against employees for:
- Special enrollment windows
- COBRA enrollment windows
- COBRA premium payment due dates
- Filing claims
- Requesting a claim review
- Perfecting a claim review