COVID Public Health/National Emergency Period Expiring – Impact on Health Insurance

The federal government has announced the current COVID-19 related Public Health Emergency and National Emergency periods will expire on May 11, 2023.  These periods were officially opened and recognized by the government effective January 27, 2020, and were intended to make it easier for the nation to deal with the pandemic.  Included among the many affected areas of our economy was the loosening of a number of health insurance and other employee benefits related coverages, timelines, and deadlines.  Employers need to prepare for the resumption of the guidance that was in place and changed, during the national state of emergency.

Public Health Emergency (PHE)
During the PHE, group health plans are required to cover the cost of COVID-19 tests and testing-related services without cost-sharing (i.e., copay, deductible, coinsurance), prior authorization, or other medical management requirements. This requirement was later expanded to include over-the-counter (OTC) home COVID-19 test kits.  Although the PHE period was slated to expire April 11, 2023, with the government’s renewal of this period to now terminate on May 11, 2023,  employer plans will no longer be required to cover such tests and services without cost sharing.

National Emergency
Several employee benefit plan related deadlines were suspended for up to one year as long as the national emergency was in place. Now that the national emergency declaration will be terminated as of May 11, 2023, the 60-day period following the end of the national emergency will begin on May 12, 2023.  Once this 60-day period ends (i.e., July 10, 2023), these suspended timeframes will begin to run again at pre-pandemic rates effective July 11, 2023, and include:

• – the 14-day deadline for plan administrators to provide COBRA election notices to qualified beneficiaries;
• – the 30-day period (or 60-day period, in some cases) to exercise HIPAA special enrollment rights in a group health plan following birth, adoption, or placement for adoption of a child; marriage, loss of other health coverage; or eligibility for a state premium assistance subsidy;
• – the 60-day deadline by which a participant or qualified beneficiary must provide notice of divorce or legal separation, a dependent child that ceases to be an eligible dependent under the terms of the plan), or a Social Security disability determination used to extend COBRA coverage;
• – the 60-day deadline in which to elect COBRA coverage;
• – the 45-day grace period for the payment of initial COBRA premium, and 30- day period for subsequent premium payments. (Note: presently, individuals electing COBRA outside of the initial 60-day election period  generally have one year and 105 days after the election notice is provided to make the initial premium payment; and individuals electing COBRA within the generally applicable 60-day election period have one year and 45 days after the date of their election to make the initial payment;
• – the deadline under the plan by which providers and participants may file a benefit claim (generally one year, under the terms of the plan); and
• – the deadlines for appealing an adverse benefit determination (generally 30 days), requesting an internal review (generally 6 months), or an external review of a claim denial (generally 4 months).

Importantly, the guidance that allowed Health Savings Account (HSA) qualified high deductible plans to offer Tele-health coverage on a first dollar basis without affecting HSA eligibility is NOT impacted by the end of the public health/national emergency.  However, this relaxation is in effect through 2024, per the Consolidated Appropriations Act (CAA).

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