Public Health Emergency
The Federal Government recently announced that the COVID Public Health Emergency and the COVID National Emergency will end on May 11, 2023.
The end of the COVID Public Health Emergency (PHE) means that all required Health Plan mandates related to COVID will also end; the one exception is that all plans will continue to be required to cover COVID vaccines without any employee cost sharing on an in-network basis. All other mandates related to COVID testing and treatment will no longer be required.
Health Plans are free to continue covering these services as they have during the Public Health Emergency, but with the ending of the PHE, Health Plans may choose to discontinue coverage or make services subject to any other cost sharing. For example, under the mandate, COVID diagnostic testing – whether in an office setting or through home tests – was required to be paid at 100%. After May 11, plans may continue to pay at 100%, completely exclude, or pay based upon a cost share applied by the plan.
Each Plan Sponsor should consider its goals when making a determination, but at this time, the overall trend appears to show most Health Plans ending coverage for out-of-network vaccines, excluding coverage for home test kits, and applying coverage for all other COVID-related services based upon the plan’s normal cost sharing requirements for similar non-COVID services.
There is no specific deadline of when or if these changes are required. Plans may choose to make any changes effective May 12, 2023, wait until their new benefit periods to do so, or to make a change at any other time (subject to the applicable notice requirements).
In addition to the above, the declared National Emergency (NE) extended a large number of Health Plan filing deadlines for ERISA plans. These include HIPAA special enrollment deadlines, COBRA election and premium payment deadlines, and claims and appeals filing deadlines. For each of these categories during the NE, the Covered Individual had an additional year of time to file or request coverage for the categories above. Effective July 10, 2023, this extension will end for all categories above regardless of when the event occurred. Deadlines for special enrollment will return to the time specified in your Plan Document, deadlines for COBRA elections will be no more than 60 days, and COBRA premiums will be due no later than 30 days after their due date. Claims must be filed no later than one year from the date they were incurred, and appeals must be filed no later than 180 days from the date of the denial of the claim.
Finally, the current safe harbor rules for High Deductible Health Plan telemedicine coverage will continue until at least December 31, 2024 and is not affected by the ending of either the PHE or NE.