Compliance News | May 1, 2020

Health and Disability Plan Deadlines Extended

The Departments of Labor (DOL) and Treasury, in coordination with the Department of Health and Human Services (HHS), have released a final rule to extend certain pre-established deadlines for plans and individuals. This relief applies to group health plans, disability plans and their participants and beneficiaries. Extended deadlines relate to the issuance of certain notices and changes in eligibility and enrollment, including COBRA election rights.

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The extended deadlines will help prevent participants and beneficiaries from losing rights and benefits under the plan. They will also help ease the administrative burden faced by plan sponsors and administrators as they navigate workforce staffing changes and disruption to normal business routines.

Although not required to do so, plan sponsors may wish to consider notifying participants about these deadline extensions in order to assure that participants understand their rights and to assure that implementation of the rules is clear for benefits administrative staff. Notification could be made through a benefits website, newsletters or other communications.

The relief the guidance provides will be effective immediately upon publication in the May 4, 2020 Federal Register.

Extended deadlines

Specifically, in determining certain deadlines, group health and disability plans must disregard the “Outbreak Period” — the period that began on March 1, 2020, when a National Emergency related to COVID-19 was declared and will end 60 days after the end of the emergency (or on another date issued by the Departments in the future).

The extended deadlines are related to:

  • HIPAA special enrollment
  • COBRA
  • Claims and appeals extensions

HIPAA special enrollment

Group health plans must allow individuals to enroll in the plan based on loss of eligibility for other coverage or acquisition of a new dependent for up to 30 days after the end of the Outbreak Period, although participants must pay any applicable premiums for coverage (60 days in the event of a special enrollment because of loss of coverage under Medicaid or the Children’s Health Insurance Program).

COBRA

Plans must extend deadlines under COBRA without regard to the Outbreak Period, including:

  • Plans must allow individuals who have experienced a qualifying event to elect COBRA until 60 days after the end of the Outbreak Period.
  • Plans must consider COBRA premiums timely if they are made within 30 days after the end of the Outbreak Period.
  • Plans must consider notification of a COBRA qualifying event by the participant (e.g., divorce, loss of dependent status or receipt of a Social Security Disability determination) timely if received within 60 days after the end of the Outbreak Period.
  • The Outbreak Period is also disregarded when calculating the deadline for plan sponsors and administrators to provide COBRA election notices. However, if possible, plan administrators should continue to provide COBRA notices to qualified beneficiaries so that they are aware of their right to continuation of coverage.

Claims and appeals extensions

Group health plans, including those with disability benefits, must extend deadlines for filing claims and appeals without regard to the Outbreak Period, including:

  • The deadline for filing a benefit claim
  • The deadline for filing an appeal of an adverse benefit determination
  • For non-grandfathered health plans, a request for external review or information to complete the request for external review

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Related guidance

In a separate notice issued by the DOL, EBSA Disaster Relief Notice 2020-01, the Department provides flexibility under certain additional ERISA provisions. Among other things, the guidance includes extended time frames for ERISA disclosures, such as Summary Plan Descriptions and for filing the Form M1. This guidance is discussed in our compliance news, DOL Filing Deadlines & Fiduciary Relief for Retirement Plans. The DOL also issued COVID-19 Answers to Frequently Asked Questions (FAQs) on health and retirement benefit issues, which is that directed to participants and beneficiaries.

Additional guidance is possible

The final rule acknowledges that to the extent there are different Outbreak Period end dates for different parts of the country, the Departments will issue additional guidance regarding the application of the relief.

Application to state and local governmental plans

There is no similar statutory authority permitting HHS to extend deadlines applicable to plan enrollees or plan sponsors of public sector plans. As a result, HHS is encouraging plan sponsors of such plans to provide relief similar to that specified in this notice to their enrollees. HHS also encourages states and health insurers to operate in a manner consistent with the relief provided in this final rule.

What plan sponsors need to monitor

Plan sponsors should assure that their administrator does not improperly deny enrollment, terminate coverage or process a claim or appeal without considering these new deadlines. Plan sponsors should stay abreast of the date the Outbreak Period will end, which may be different in different parts of the country. They should also be alert to an influx of claims, appeals and elections after the Outbreak Period ends.

The information on this webpage is preliminary and subject to revision after guidance is issued. On all issues involving the interpretation or application of laws and regulations, plan sponsors should discuss the issues raised here with their legal, tax and other advisors before determining how they apply to their specific situation.

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