The end of the COVID-19 Emergency Period is almost here…what’s that mean for Health Plans?
By Michelina Covey
After almost 3 years of the declared National and Public Health Emergency (PHE) for COVID, the Biden Administration announced the end of the National and Public Health Emergency will be May 11, 2023.
As we are finally rounding the corner to what life used to be like pre-COVID, as it relates to Health and Welfare Benefits plans, does anyone actually remember what those days were like? We’ve all become so accustomed to what we’ve been doing in the now that the last 3 years seem like a distant memory for most of us. With so many changes, amendments, new regulations, additional reporting and extensions we were faced with, let’s review what will be changing as many have been and will continue to be impacted:
- COVID-19 Testing:
Under FFCRA and the CARES Act, COVID-19 diagnostic tests were provided without cost sharing (deductibles, copays, or coinsurance), prior authorization, or other medical management requirements. These provisions are set to expire on May 11, 2023, when the public health emergency ends. Consequently, group health plans and insurers will no longer be required to cover COVID-19 at-home or in-person diagnostic tests without cost sharing.
- COVID-19 Vaccines:
As with COVID-19 testing, vaccines were also tied to the public health emergency. After May 11, 2023, COVID-19 vaccinations will still be covered without cost (similar to other preventive care vaccines) by health plan and insurers. However, employers will no longer be required to cover vaccines obtained out-of-network.
Standalone Telehealth Benefits:
After May 11, 2023, these types of standalone arrangements will no longer be permitted.
For plan years that began during the PHE, a large employer (more than 50 employees) could offer standalone telehealth benefits and other remote care services to individuals who were not eligible for coverage under any other group health plan offered by the employer without violating the ACA.
Additionally, self-funded groups had the option to eliminate cost sharing for telehealth when a qualified High Deductible Health Plan with an HSA was present as it was deemed preventive care during the PHE. This will also be coming to an end.
- COBRA Extensions:
COBRA extensions, as mentioned in the COVID-19 Extension Final Rule and ESA Disaster Relief Notice 2021-01, will expire on July 10, 2023 (which is 60 days after the end of the national emergency). This applies to the following:
- HIPAA special enrollment election;
- COBRA continuation coverage election;
- Participant or Qualified Beneficiary to notify a plan of a qualifying event or disability determination;
- Timeframe for the plan to provide a COBRA election notice;
- COBRA premium payments; and
- Timeframe for a participant to file claims, appeals, and requests for external review.
So what does this mean for plan participants? It’s been so long since the “original” COBRA provisions have been in effect. Here’s an example of how the end of the PHE translates to COBRA, with dates:
If individual received their COBRA election notice on October 1, 2022, the time from October 1, 2022, through July 10, 2023, is disregarded due to the COVID-19 Extension Final Rule. However, after the outbreak period ends on July 10, 2023, the individual would have until 60 days after July 10, 2023, to elect COBRA, or September 8, 2023.
COBRA, even when not dealing with the nuances of a national emergency, is complicated to administer and any missed deadlines can get quite costly for the employer. It is highly recommended employers consider outsourcing this function. If you’re interested in potential outsourcing, reach out to your respective Client Manager.
So what does this mean? What should you be doing now? Although there are no actions to be taken at this time, it is highly recommended employers work with their carriers, TPAs or other vendors to ensure proper communication is delivered impacting plan participants. This includes reviewing any plan materials, such as SPDs, describing coverage for COVID-19 vaccines by the plan and should be amended as necessary.
Are we finally nearing the end of this unprecedented time and headed back to normal life as we once knew it? I’m not sure anyone knows what normal is these days, but we’re certainly making changes…again.