When will the pandemic end for the Employer Health Plan? | Newsletters | Legal News: Employee Benefits Insights

Although in many ways the COVID-19 pandemic seems to be over, there are still many special rules born out of the pandemic that directly or indirectly affect employers ’health plans. In this article, we will answer some questions about the special rules that are still in force and how to prepare for the end of these special rules by the sponsors of the employers’ plans.

What is the state of the National Emergency?

As we wrote earlier in the May 2020 and March 2021 articles, several terms related to the employer plan are extended during a “Appearance Period” of COVID-19. The rally began in March 2020, when President Trump declared COVID-19 a National Emergency, and will end 60 days after the end of the current National Emergency. As a reminder, the following are some of the major extensions:

  • Extend the time limit for filing a claim, appeal or requesting an external review.
  • Extension of the COBRA election period, the COBRA payment period, and the extension of the COBRA deadlines to report a qualifying event or a new disability to the plan.
  • Extension of the 30 or 60 day window for sending a special HIPAA enrollment application.

These extensions will expire at the end of the Appearance Period (60 days after the end of the National Emergency), or after any person has the right to receive specific assistance within one year.

Are there any other emergency statements that affect our plans?

In addition to the National Emergency, the Secretary of Health and Human Services (HHS) declared a Public Health Emergency in January 2020 and has repeatedly acted to extend that declaration for 90-day periods. As a reminder, while the Public Health Emergency is in effect:

  • Employer health plans must cover the cost of COVID-19 diagnostic tests and related services without sharing participant costs, or without prior authorization or other medical management requirements. As of January 15, 2022, this coverage was extended to free prescription (OTC) testing.
  • Employers may offer an autonomous tele-health benefit, which is not subject to other provisions that would prohibit the provision of a tele-health benefit to employees who are not even enrolled in the General Medical Coverage Act and, in general, employer-only medical coverage.

Are there any other provisional rules still in force?

  • The CARES Act allowed for pre-deductible coverage for telehealth services for people with high-deductible health plans (HDHPs), including those related to health savings accounts (HSAs), until 2021. As discussed in detail in our April 2022 article, Congress. It acted to renew this special subsidy by approving the Consolidated Budget Act (CAA) of 2022, but this renewal is only in force from 31 March 2022 to 31 December 2022.
  • The CARES Act required employers ’health plans to cover the cost of COVID-19 vaccines while the Public Health Emergency is in effect, and this condition is now permanent because it has become a preventive service under the rules of the Affordable Care Act requiring first dollar coverage for Prevention. take care.
  • During the pandemic, the federal government covered the cost of many of the costs associated with COVID-19 on behalf of the public, including paying for vaccines and purchasing and supplying kits for prescription testing. These public health expenditures will be of a temporary nature and may be terminated sooner or later when the National Emergency and the Public Health Emergency are formally terminated. This is significant for employers ’health plans, which will shift the financial burden of paying for vaccines and tests currently being covered by the federal government to employers’ plans.

When will these special rules end?

As of this article:

  • The National Emergency will end on February 28, 2023, with no action by the White House to extend or cut it.
  • The Public Health Emergency will end on October 12, 2022, with no action by HHS to extend that date.
  • The HDHP / teleosity provision will expire on December 31, 2022, unless Congress decides to extend it again.

HHS has stated that it will notify the public 60 days before the end of the Public Health Emergency. We would also expect the White House to announce the end of the National Emergency in advance. There is also talk that the White House and HHS could coordinate to end the Public Health Emergency and the National Emergency at the same time, but that is just speculation at the moment.

Is there anything we should do to be ready when these Temporary Provisions expire?

Most employer health plans have made formal and informal adjustments to their processes in accordance with the special provisions set out above. However, the above-mentioned employers also want to consider the following actions in preparation for the end of the relief period:

  • When the National Emergency ends, the COBRA deadlines must be met again. Plans must ensure that all persons eligible for COBRA for relief are properly identified in the enrollment systems. This is important, from a trustworthy point of view, because you want to inform the affected people of the end date. In addition, the end date will not be the same for all people in the extended COBRA election or pay window, so it will be important to monitor the relevant dates.
  • Employers who have offered free teleosity to HDHP participants should think that you will not be able to continue with this free teleosity benefit in 2023 and plan accordingly while you are preparing for 2023 benefits.
  • Employers who have provided free telephony to all employees, regardless of whether or not they are enrolled in your primary health care plan, your plan should limit free telephony to employees who are enrolled in a non-HDHP general medical plan. and if it ends next year in 2024.
  • Also, in terms of 2023 planning, employers may want to consider whether their health plan will continue to cover COVID-19 testing at no cost, or reimburse the cost of over-the-counter COVID-19 testing when no such coverage is required. according to the law.
  • When considering what coverage a plan would offer after several periods of COVID-19 relief, that plan should take into account that the agency’s enforcement has been paid for in many departments during the pandemic. For example, certain enforcements of the Mental Health Equality and Addiction Act (MHPAEA) were established during the pandemic if a plan covered COVID-19 testing items and services without cost sharing. However, at the end of the Public Health Emergency, this coverage may raise parity concerns when assessed under the MHPAEA.
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