Where We Are: COVID-19 Relief and Health Plans

Throughout the coronavirus pandemic, many relief measures have been enacted, from stimulus payments to extended deadlines to COBRA subsidies. Keeping up with these relief measures, how long they apply and what employers need to do to stay compliant can be most challenging. With expiration dates right around the corner, it’s important to know what’s coming in terms of COVID-19 relief and health plans. But before we get into that, how did we get here to begin with?

The following is summarized from a recent report by Mercer, the global health and benefits consultant:

Public Health Emergency Status

In January 2020, a Public Health Emergency (PHE) was declared by the Secretary of the Department of Health and Human Services (HHS). During a PHE, the HHS Secretary can take a variety of actions to help the public with healthcare needs. These range from making grants, to investigating the cause/treatment/prevention of a health issue, to accessing emergency reserve funds and a lot more.

The PHE status has been extended several times as the pandemic has continued. Each extension lasts for a period of 90 days. Unless extended again in the interim, the PHE is currently scheduled to expire on January 15, 2022.

During the COVID-19 PHE:

  • Group health plans must provide COVID-19 diagnostic testing and related services without any participant cost sharing, prior-authorization requirements or other medical-management standards whenever an authorized provider deems the testing medically appropriate
  • An employee assistance program may remain an excepted benefit even if coverage for COVID-19 diagnostic testing is added.
  • Employers may offer stand-alone telehealth to employees who are not eligible for other health coverage from that employer and avoid many group health plan mandates under ERISA, the ACA and other laws
  • The 60-day advance notice requirement for certain changes to a summary of benefits and coverage (SBC) is waived
  • Group health plans may maintain grandfathered status even if they later revoke benefits added during the PHE
  • Some HIPAA privacy rules are relaxed

COVID-19 Relief and Health Plans: National Emergency Status

A “national emergency” differs from a PHE and can only be declared by the President. On March 13, 2020, former President Trump declared a coronavirus outbreak national emergency effective March 1, 2020. After taking office, in February 2021, President Biden renewed it. The current declaration will end automatically on March 1, 2022, unless renewed again.

During the COVID-19 national emergency, group health plans must extend certain deadlines that would have expired during the “outbreak period.” The outbreak period began March 1, 2020, and will end 60 days after the end of the national emergency or other date announced by the enforcing agencies. For example, if the national emergency expires on March 1, 2022, the outbreak period will end 60 days later on April 30, 2022.

The national emergency and outbreak period relief extends the:

  • Deadlines for participants to file a benefit claim, to appeal a denied claim, and to request or perfect an external review of a denied claim
  • 60-day COBRA election period, the timeframe for making initial and on-going timely COBRA premium payments and the date for individuals to notify the plan of a COBRA qualifying event or determination of disability (see IRS Notice 2021-58 for recent clarifications)
  • 30-day period (or 60-day period in certain circumstances) to request special enrollment rights under HIPAA

Telehealth, HSAs and HDHPs

Temporary relief permits HSA-qualifying HDHPs to cover telehealth and other remote care services before individuals have met their deductible, without jeopardizing their eligibility to make or receive HSA contributions. This important relief is not tied to either the PHE or national emergency described above.

If an employer offers a Health Savings Account (HSA) through a qualified High Deductible Health Plan (HDHP), first-dollar or pre-deductible telehealth coverage expires at the end of the plan year that began in 2021 (for calendar year plans, the expiration date is December 31, 2021).

Unless extended or made permanent by Congress, HDHPs will need to start charging patients for any pre-deductible telehealth services that are not HSA-compatible preventive care.

When Does the Relief End?

Applicable periods for the the above mentioned provisions start either one year after the eligibility for relief first started, or 60-days after the national emergency ends.

Looking Ahead

If the upcoming expiration dates are not extended again, a lot of changes are coming in the next three to six months in terms of COVID-19 relief and health plans. Further, at this writing the Biden Administration is in the process of implementing even more changes as part of a plan called “Path Out of the Pandemic” that includes various initiatives to help the country move out of emergency status and into recovery.

Employers need to prioritize supporting the health of their employees in order to work toward a new normal. Non-compliance with all of the temporary rules and regulations could create major headaches…literal and financial. Turn to your benefits counsel, benefits broker and third-party administrator (TPA) for assistance in ensuring your company is complying with all aspects of the PHE and national emergency.

For 40 years, DataPath has been a pivotal force in the employee benefits, financial services, and insurance industries. The company’s flagship DataPath Summit platform offers an integrated solution for managing CDH, HSA, Well-Being, COBRA, and Billing. Through its partnership with Accelergent Growth Solutions, DataPath also offers expert BPO services, automation, outsourced customer service, and award-winning marketing services.

Home » Where We Are: COVID-19 Relief and Health Plans
DataPath - No Boundaries

Subscribe below to receive important news and updates!

  • Breaking industry news
  • Critical regulatory updates
  • Insightful research and whitepapers
  • Educational blog articles