Evolution Healthcare

May 12, 2020 by Evolution Healthcare's Editorial Team

Summary of COVID-19-Related Regulatory Guidance Delaying Certain Participant, Plan Deadlines

The Department of Labor (DOL) and Treasury released guidance delaying certain participant deadlines. The rule is effective immediately and not subject to notice and comment.

Duration of Relief

The rule provides that in determining certain plan time frames, the duration of the “outbreak period” is to be disregarded. The outbreak period is the period from March 1, 2020 until 60 days after the end of the national emergency or another date announced by DOL and Treasury in a future notice.

The rule provides that, to the extent there are different outbreak period end dates for different parts of the country, DOL and Treasury will issue additional guidance. The rule also notes that, per the statutory provisions in the Internal Revenue Code and ERISA that provide the basis for these extensions, the period required to be disregarded may not be longer than one year.

Extensions for Participants

In order to minimize the possibility of individuals losing benefits because of a failure to comply with certain pre-established time frames, the rule requires that plans disregard any days within the outbreak period when determining the periods and deadlines noted below for all plan participants, beneficiaries, qualified beneficiaries and claimants, regardless of where the individuals are located.

For group health plans, this includes:

  • The 30-day period (or 60-day period, in the case of loss of Medicaid or CHIP or eligibility for premium assistance under Medicaid or CHIP) to request special enrollment in a group health plan.
  • The 60-day election period for COBRA continuation coverage.
  • The deadline for making COBRA premium payments.
  • The date for individuals to notify the plan of a COBRA qualifying event related to the employee’s divorce or a dependent child ceasing to be a dependent child, and the date for individuals to notify the plan of a determination of disability.
  • The date by which a claimant may file a request for an external review after receipt of an adverse benefit determination or final internal adverse benefit determination.
  • The date by which a claimant may file information to perfect a request for external review upon a finding that the request was not complete.
  • The date by which individuals may file a benefit claim under the plan’s claims procedures.
  • The date by which claimants may file an appeal of an adverse benefit determination under the plan’s claims procedures.

Plan Relief

The rule also states that because group health plans may have difficulty complying with COBRA notice obligations, the outbreak period is disregarded when determining the deadline by which a group health plan, plan sponsor and/or plan administrator must provide a COBRA election notice to participants.

Examples and Future Guidance

The rule includes a number of examples to illustrate how these rules apply, and the rule also notes that DOL and the Treasury Department are continuing to monitor the COVID-19 outbreak and may provide additional relief as warranted.

Health and Human Services (HHS) Coordination

The rule applies to group health plans, disability and other employee welfare benefit plans, and employee pension benefit plans subject to ERISA or the tax code. However, the rule also notes that HHS concurs with the relief specified in the rule and generally provides that HHS will adopt similar extensions for non-federal governmental group health plans and health insurance issuers offering coverage in connection with a group health plan, and their participants and beneficiaries.

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