When will the pandemic be over for employer health plans? | Newsletters | Legal Update: Overview of Employee Benefits

Although in many ways it seems that the COVID-19 pandemic is over, there are still many special rules born out of the pandemic that directly or indirectly affect employer health plans. In this article, we’ll answer some questions we receive from employer plan sponsors about the special rules that are still in effect and how to prepare for the end of those special rules.

What is the national emergency status?

As we previously wrote in articles from May 2020 and March 2021, various deadlines related to the employer plan are being extended during a COVID-19 “outbreak period”. The outbreak period began in March 2020, when President Trump declared a COVID-19 national emergency, and will end 60 days after the end of that national emergency, which is still in effect. As a reminder, here are some of the main deadline extensions:

  • Extension of time to file, appeal or request external review of a claim.
  • Extended COBRA election period, COBRA payment due date, and COBRA deadlines for notifying the plan of a qualifying event or new disability.
  • Extended 30- or 60-day window to submit a HIPAA Special Listing Request.

These extensions will end at the end of the outbreak period (60 days after the end of the national emergency) or after a person has been eligible for specific assistance for a period of one year.

Are there any other emergency declarations that still affect our plans?

In addition to the national emergency, the Secretary of Health and Human Services (HHS) declared a public health emergency in January 2020 and acted repeatedly to extend this declaration for periods of 90 days. As a reminder, while the public health emergency is in effect:

  • Employer health plans must cover the cost of COVID-19 diagnostic testing and related services without any participant cost sharing, nor the need for prior authorization or any other medical management requirements. As of January 15, 2022, this coverage has extended to over-the-counter (OTC) testing.
  • Employers can offer a stand-alone telehealth benefit that is not subject to the Affordable Care Act and other provisions that would generally prohibit an offer of telehealth benefits to employees who are not also enrolled in medical coverage principal of the employer.

Are there any other temporary rules still in effect?

  • The CARES Act allowed pre-deductible coverage of telehealth services for people with high-deductible health plans (HDHPs), including those tied to health savings accounts (HSAs), through 2021. As discussed detailed in our April 2022 article, Congress acted to renew this special relief by passing the Consolidated Appropriations Act (CAA) of 2022, but this renewal is only effective from March 31, 2022 through December 31, 2022.
  • The CARES Act required employer health plans to cover the cost of COVID-19 vaccines while the public health emergency is in effect, and that requirement is now permanent as it has become a preventative service under the rules of the Affordable Care Act that requires first-dollar prevention coverage to worry about.
  • During the pandemic, the federal government covered the cost of many COVID-19-related expenses on behalf of the public, including paying for the vaccines themselves and purchasing and providing over-the-counter test kits. These public health expenditures are likely temporary in nature and may end when the national emergency and public health emergency officially ends or shortly thereafter. This is important for employer health plans because it will shift the financial burden of paying for vaccines and tests that the federal government currently covers onto employer plans.

When will these special rules end?

As of the date of this article:

  • The national emergency will end on February 28, 2023, unless action is taken by the White House to extend or shorten it.
  • The public health emergency will end on October 12, 2022, unless HHS takes action to extend that date.
  • The HDHP/telehealth provision expires on December 31, 2022 unless Congress acts again to extend it.

HHS said it would give the public at least 60 days notice before the public health emergency officially ends. We would also expect the White House to announce the end of the national emergency in advance. There are also talks that the White House and HHS could coordinate so that the public health emergency and the national emergency end at the same time, but that’s just speculation at this point.

Do we need to do anything to prepare for the expiration of these temporary arrangements?

Most employer health insurance plans have made formal and informal adjustments to their processes in light of the special provisions noted above. That said, even employers who are on top of this may want to consider the following actions to prepare for the eventual end of respite periods:

  • At the end of the national emergency, the COBRA deadlines will again have to be applied. Plans should ensure that all COBRA-eligible individuals receiving extended timelines in light of the relief are properly identified in enrollment systems. This is important because from a fiduciary perspective you will want to communicate the end date to those involved. Also, the end date will not be the same for everyone who is within the extended COBRA election or payment window, so it will be important to track all relevant dates.
  • For employers who have offered free telehealth to HDHP participants, you should assume that you will not be able to continue receiving this free telehealth benefit in 2023 and plan accordingly when preparing your 2023 benefits.
  • For employers who have offered free telehealth to all employees, whether or not they are enrolled in your major medical plan, your planning should include the need to limit any free telehealth to employees enrolled in a non-HDHP major medical plan, 2023 if the public health emergency ends this year and 2024 if it ends next year.
  • Additionally, when planning for 2023, employers may want to consider whether their health insurance plan will continue to cover non-cost-sharing COVID-19 testing or reimburse the cost of over-the-counter COVID-19 testing. when this coverage is no longer needed. by the law.
  • In considering the coverage a plan would provide after the various COVID-19 relief periods end, that plan should take into account that agency law enforcement has taken its toll on many departments during the pandemic. . For example, some enforcement under the Mental Health Parity and Substance Abuse Equity Act (MHPAEA) was enforced during the pandemic if a plan covered testing items and services. COVID-19 without cost sharing. However, at the end of the public health emergency, such coverage may raise parity issues when assessed under the MHPAEA.
As part of Foley’s ongoing commitment to providing legal insights to our clients and colleagues, our Employee Benefits and Executive Compensation Group publishes a monthly newsletter we call “Employee Benefits Insights”, in which we provide you updates on the latest and most pressing employee issues. benefits and other related matters. Click here or click the button on the left to subscribe.

Harry L. Blanchard