The U.S. Department of Labor and Internal Revenue Service have issued a new regulation that requires 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. Below is a brief outline of MedCost’s plan for implementing these changes and a more detailed overview of the deadlines impacted.
Implementation
MedCost will implement the changes required by this regulation without requiring any further action from employers or plan sponsors. Plans that have not elected MedCost’s COBRA Administration Services should ensure that the COBRA-related changes are implemented by their COBRA administrator(s).
Both ERISA and the Internal Revenue Code permit plans to implement these deadline extensions without a formal plan amendment. As such, MedCost does not intend to prepare plan amendments to address these changes, pending confirmation that stop loss carriers are supportive of this approach. MedCost is in the process of obtaining such confirmation for MedCost-placed stop loss policies. For plans with stop loss policies not placed by MedCost, we are requesting brokerage firms confirm the same with the plan’s stop loss carrier.
Extension Period
Each of the impacted deadlines described in more detail below will be extended by disregarding the duration of the “Outbreak Period” when calculating the deadline. The Outbreak Period is defined as the period of time that began on March 1, 2020, and extends until 60 days following the announced end of the COVID-19 National Emergency (as declared by the President). However, in no event will the Outbreak Period be longer than one year with the respect to a particular deadline that applies to in individual. This means that any deadline that applies to you will not be extended for longer than one year but could be shorter.
Deadlines Impacted
Special Enrollment Periods
- 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
- 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
- The 30- or 60-day deadline for employers or individuals to notify the plan of a qualifying event;
- The 60-day deadline for individuals to notify the plan of a determination of disability;
- The 14-day deadline for plan administrators to furnish COBRA election notices;
- The 60-day deadline for participants to elect COBRA; and
- 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
- Deadlines for filing claims for benefits and for initial disposition of claims; and
- Deadlines for providing claimants a reasonable opportunity to appeal adverse benefit determinations under ERISA plans and non-grandfathered group health plans.
External Review Process
- 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
- Other deadlines that apply for perfecting an incomplete request for review.
Please do not hesitate to contact your Account Manager with any questions.