The Biden administration intends to end the national emergency and public health emergency declarations (Emergency Declarations) attributable to the COVID-19 pandemic on May 11, 2023. The COVID-19 pandemic brought multiple temporary changes for ERISA-governed group health and welfare plans that will sunset at the conclusion of the Emergency Declarations. It remains to be seen what, if any, guidance will come from the regulatory agencies outlining how these mandates will be phased out or, potentially, if any continuing obligations will remain.
While we wait for this guidance, now is a good time for plan sponsors and third-party administrators to start to plan for the conclusion of the following mandates:
- Plans will no longer be required to cover COVID-19 diagnostic testing and related services (including tests administered by providers and over-the-counter tests) without cost sharing (i.e., deductibles, co-pays, or co-insurance), prior authorization, or other medical management requirements.
- Plans will no longer be required to cover COVID-19 vaccines—including booster doses—from out-of-network providers without cost sharing, prior authorization, or other medical management requirements.
- The deadlines for the following actions will no longer be extended:
- The 30-day period (or 60-day period, if applicable) to request HIPAA special enrollment.
- 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 COBRA qualifying event or new disability.
- The date for plan sponsors and administrators to provide a COBRA election notice (typically within 14 days after the plan receives notice of a qualifying event).
- The date within which individuals may file a benefit claim under a plan’s claims procedures.
- The deadlines for requesting internal and external appeals for adverse benefits determinations.
- Consider whether the plan will continue to cover COVID-19 testing and/or out-of-network vaccines without cost sharing, prior authorization, or other medical management requirements. Note that plan sponsors that wish to continue coverage for testing without cost sharing will not be able to do so under a high-deductible health plan until the participant has satisfied the deductible.
- Remember that statutory changes flowing from the CARES Act require non-grandfathered group health plans to continue to cover COVID-19 vaccines from in-network providers at no cost as a preventive service.
- Consider sending communications to participants and qualified beneficiaries notifying them of the end of the Emergency Declarations and the associated impact.
- Consider extending any imminent deadlines to minimize the impact on participants and beneficiaries—a plan fiduciary could decide to extend any deadlines that are expected to expire upon the conclusion of the Emergency Declarations.
- Review plan documentation and participant communications to ensure all materials accurately reflect that the above deadlines are no longer extended and remove any references to the Emergency Declarations.