President Biden has announced the conclusion of the COVID-19 National Emergency and the Public Health Emergency (PHE), under Section 319 of the Public Health Service (PHS) Act, as of May 11, 2023.
Background
The PHE was announced at the beginning of 2020, giving the federal government flexibility to waive or modify certain requirements in a variety of areas, including self-insured health plans. Additionally, Congress enacted several laws in response to the PHE declaration —including the Families First Coronavirus Response Act (FFCRA), the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the American Rescue Plan Act (ARPA), the Inflation Reduction Act (IRA), and the Consolidated Appropriations Act, 2023 (CAA). These pieces of legislation provided additional flexibility tied to one or more of these emergency declarations, and as such they are set to expire when or at a specified time after the emergency period expires.
Impact On Self-Insured Health Plans
Testing
As you know, during the PHE, plans were required to cover COVID-19 testing and related services without cost-sharing for both in-network and out-of-network providers, prior authorization, or other medical management requirements. In January 2022, the federal government expanded the mandate by requiring health plans and insurers to cover OTC COVID-19 test kits at retail pharmacies as a part of their pharmacy benefit with no upfront cost to the member. Following the expiration of the PHE, these mandates no longer apply.
This will provide plans with some flexibility in plan design regarding COVID-19 diagnostic testing and other related services. Plans may continue coverage of COVID testing, including OTC tests, without cost share if they choose to do so, subject to their Pharmacy Benefit Manager’s ongoing capability to manage such benefits. It is important to note that coverage for testing without cost-sharing will automatically end on May 12, 2023. Alternatively, plans may choose to cover COVID-19 testing the same as all other laboratory tests.
Vaccines
The end of the PHE also impacts coverage requirements for COVID-19 vaccines. During the PHE, all grandfathered and non-grandfathered plans were required to cover COVID-19 vaccines, including booster doses, from out-of-network providers, without prior authorization, or other medical management requirements. For grandfathered plans, this requirement will no longer apply. For non-grandfathered plans, however, coverage of in-network COVID-19 vaccines without cost sharing will continue to be required under the Affordable Care Act’s preventive services coverage mandate. Out-of-network vaccine coverage is no longer required.
Plan Related Deadlines
In 2020, the Department of Labor and the Internal Revenue Service issued regulations requiring health plans to extend certain deadlines related to special enrollment periods, COBRA continuation coverage, claims filing, and appeals due to the COVID-19 National Emergency. Those regulations stated that the duration of the extension would be calculated based on the “Outbreak Period” — beginning March 1, 2020, and extending until 60 days following the announced end of the COVID-19 National Emergency.
Therefore, as of July 10, 2023, all the deadlines will revert to their original timeframes as prescribed by each individual regulation.
Deadlines Impacted
The following deadlines will revert to their normal pre-COVID timelines as of July 10, 2023:
Special Enrollment Periods
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The 30-day special enrollment periods that may be triggered when eligible employees or dependents lose eligibility for other health plan coverage in which they were previously enrolled, and when an eligible employee acquires a dependent through birth, marriage, adoption, or placement for adoption; and
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The 60-day special enrollment periods that may be triggered by changes in eligibility for state premium assistance under the Children’s Health Insurance Program.
COBRA
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The 30- or 60-day deadline for employers or individuals to notify the plan of a qualifying event;
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The 60-day deadline for individuals to notify the plan of a determination of disability;
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The 14-day deadline for plan administrators to furnish COBRA election notices;
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The 60-day deadline for participants to elect COBRA; and
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The 45-day deadline in which to make a first premium payment and 30-day deadline for subsequent premium payments.
Claims Procedures and Appeals for ERISA Plans
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Deadlines for filing claims for benefits and for initial disposition of claims; and
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Deadlines for providing claimants a reasonable opportunity to appeal adverse benefit determinations under ERISA plans and non-grandfathered group health plans.
External Review Process
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Non-grandfathered group health plan deadlines for providing the required state or federal external review process following exhaustion of the plan’s internal appeals procedures; and
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Other deadlines that apply for perfecting an incomplete request for review.
Impact on High Deductible Health Plans
IRS Notice 2020-15 granted plan sponsors the flexibility during the PHE to voluntarily cover COVID-19 testing and treatment under a high deductible health plan (HDHP) without participant cost-sharing without jeopardizing the HSA-eligibility of plan participants enrolled. This notice provided that the relief would last only “until further guidance is issued.” To date, there has been no indication that this relief will end due to the ending of the PHE. Thus, HDHPs can continue to provide coverage in this manner without jeopardizing HSA-eligibility until further notice.
As it relates to telehealth coverage for HDHPs, the Consolidated Appropriations Act of 2023 (CAA) extended the COVID-era HSA safe harbor allowing HDHPs to offer telehealth services with no cost-share to the plan participant without disturbing HDHP plan participants’ ability to make pre-tax contributions into their health savings accounts. That extension currently lasts until January 1, 2025. The end of the PHE does not have any impact on plan sponsors of HDHPs who have opted to provide coverage at the “first-dollar” benefit.
MedCost will continue to monitor for any changes to these HDHP flexibilities.
WHAT ACTION IS NEEDED?
Plan sponsors should evaluate which COVID-19 benefits they would like to continue or change, if any. Contact your Account Manager to discuss any changes to your plan as a signed plan amendment may be required.