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Feds to Pause Many Benefits Action Periods Till After Outbreak Period Ends

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Officials at the Employee Benefits Security Administration (EBSA) say they have worked with the Internal Revenue Service and the U.S. Department of Health and Human Services (HHS)  to give workers a lot more time to respond to common types of benefits action notices.

EBSA and IRS officials write in the new final rule draft that the rule will ease the:

  • The Health Insurance Portability and Accountability Act of 1996 (HIPAA) coverage access request deadline.
  • The Consolidated Omnibus Budget Reconciliation Act of 1985  (COBRA) group coverage continuation request deadline.
  • The COBRA coverage continuation premium payment deadline.
  • The Patient Protection and Affordable Care Act of 2010 (PPACA) benefits claim decision appeal and external review deadlines.
  • A benefit plan’s benefit claim filing deadlines.
  • The deadlines benefit plans must meet when they send out COBRA continuation coverage eligibility notices.

The final regulation timeframe rules will affect any type of benefit plan affected by the claim filing deadline rules, the claim appeal and external review deadline rules, and the coverage continuation deadline rules, not just group health plans, EBSA and IRS officials write.

Resources

In a proclamation issued March 13, President Donald Trump declaring March 1 to be the start of the COVID-19 national emergency.

For the purposes of the new final regulations, EBSA, the IRS and HHS will define a date 60 days after the official end of the COVID-19 national emergency to be the end of the COVID-19 outbreak period, officials from EBSA and IRS write in the draft of the final COVID-19 outbreak timeframe regulations.

Plans and enrollees should ignore the outbreak period — the COVID-19 national emergency period, plus 60 days — when applying the affected benefits provision deadlines, officials write.

An Example

The officials gave examples based on a fictional scenario: The COVID-19 national emergency will end Thursday — April 30.

The first example involves a worker who is working fewer hours due to COVID-19, loses employer-sponsored health coverage, and is eligible to pay to continue the employer health coverage using COBRA coverage continuation rules.

In the example, the employer sends the worker a COBRA election notice April 1.

Normally, the worker’s COBRA election period would end 60 days after April 1. or sometime in late May.

Under the new final regulations, officials write, the 60-day election period will start at the end of the COVID-19 outbreak period.

If the COVID-19 national emergency ends April 30, that means the COVID-19 outbreak period will end 60 days later, or on June 29, officials write.

The 60-day COBRA election period will start June 29, and the worker will have to decide whether to take up COBRA coverage by Aug. 28, the officials write.

The Procedure

EBSA is the arm of the U.S. Department of Labor that oversees large employer-sponsored benefit plans, including group health plans, group disability plans and 401(k) plans.

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It works with the IRS, which is an arm of the U.S. Treasury Department, to use tax penalties to enforce benefits rules, and it works with HHS to shape rules involving health insurance.

EBSA, the IRS or HHS often post various versions of regulations on their websites, and they officially publish regulatory documents by putting them in the Federal Register.

EBSA seems to have circulated the draft of the final COVID-19 benefits deadline regulation mainly by email, and EBSA officials note that the draft has just been submitted to the Office of the Federal Register.

At press time, the final regulation draft was not yet posted on the Federal Register’s preview site.

EBSA officials often team up with both the IRS and HHS to issue regulations, and batches of guidance interpreting regulations.

HHS is not on the current list of agencies responsible for issuing the new final regulations.

HHS has reviewed the final regulations draft, and it has told EBSA and the IRS that “HHS concurs with the relief specified in this document,” EBSA and IRS officials write in the final regulations. “HHS has advised the agencies that HHS will exercise enforcement discretion to adopt a temporary policy of measured enforcement to extend similar timeframes otherwise applicable to non-federal governmental group health plans and health insurance issuers offering coverage in connection with a group health plan, and their participants, beneficiaries and enrollees.”

HHS will ask state regulators to make similar kinds of relief available under state-level notice and deadline requirements, the EBSA and IRS officials write.

The regulation contact people listed are Elizabeth Schumacher, at the Labor Department; David Sydlik and Thomas Hindmarch of EBSA; and William Fischer of the IRS.

The End of the Outbreak Period

EBSA and IRS officials write in the new final regulations that, in a future notice, they could change the official end of the outbreak period, for purposes of the new regulations, to some date other than 60 days after the end of the COVID-19 national emergency.

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