On January 30, 2023, the Biden Administration announced its intent to end the Public Health Emergency and the National Emergency related to the COVID-19 pandemic on May 11, 2023. They are currently set to expire after February 28, 2023 and on April 11, 2023, respectively.
This announcement came in response to two bills in the House of Representatives proposing to end the national emergencies at an earlier date.
As previously reported, various employee benefit plan requirements are directly impacted by the Public Health Emergency and the National Emergency. Employers sponsoring health and welfare programs will need to make some decisions with respect to their programs.
When the Public Health Emergency (“PHE”) ends on May 11, 2023 various requirements as they relate to group health plan coverage, along with some helpful relief, will come to end.
Employers should review these changes and decide how to manage the expiration in May of these requirements. Carriers and third-party administrators (“TPAs”) may also issue information for you to review and provide directions on next steps. In some cases (and to the extent allowed) carriers or TPAs may make changes with the next plan year.
The Outbreak Period started March 1, 2020. It applies on an individual basis to group health plans, disability, and other employee welfare programs. Government plans (e.g., a health plan of a city or county) are not required to comply.
During this time, a plan must disregard the period of one year from the date an individual is first eligible for relief, or 60 days after the announced end of the National Emergency, whichever occurs first, when determining the following:
With the announced end of the National Emergency on May 11, 2023, the Outbreak Period will end July 10, 2023. This means original deadlines will begin to run after July 10, 2023.
It should be noted that there is retroactive application with respect to COBRA, special enrollment rights for birth of a child or adoption, and claims.
Hopefully, additional guidance as it relates to the end of the Outbreak Period and measuring deadlines is forthcoming. There are many unanswered questions as it relates to this relief.
In addition, there is fiduciary relief available during the Outbreak Period as it relates to certain notice and disclosure deadlines. Notably, many employers took advantage of good faith relief that allowed furnishing of certain notices and disclosure through electronic means, such as email or text, without having to satisfy more burdensome electronic delivery requirements. This relief will also expire after July 10, 2023.
There is other relief for qualified high deductible health plans (“HDHPs”) with a health savings account (“HSA”) that came about as a result of the COVID-19 pandemic but is not tied to the PHE or National Emergency. As such, these provisions should not be affected when these timeframes end.
As a result of the end of the PHE, it is expected that many individuals will lose eligibility for Medicaid and the Children’s Health Insurance Program (“CHIP”). The loss of Medicaid or CHIP coverage is a special enrollment opportunity onto a group health plan sponsored by an employer. Employers should be prepared to address requests for special enrollment from otherwise eligible employees who lose Medicaid or CHIP coverage.
With respect to the end of the PHE, employers should discuss benefit plan design changes with carriers and TPAs. Employers should be prepared to address requests for special enrollment as a result of a loss of eligibility for Medicaid or CHIP.
Employers should also monitor developments as the government funding to purchase COVID-19 vaccines is expected to end. Most group health plans will need to cover the cost of the vaccine as required preventive care (along with the administration) in-network and without cost-sharing. Reports from Pfizer and Moderna indicate the commercial cost could range between $110-130 per dose.
With respect to the end of the Outbreak Period, employers should:
Our Advisors offer in-depth analysis and are ready to help you successfully navigate employee benefits and health insurance.