COVID-19 Deadline Extensions and Coverage Mandates for Benefit Plans Scheduled to End

Smith Gambrell Russell

 

On January 30, 2023, the Biden Administration announced its plan to end the COVID-19 public health and national emergency declarations on May 11, 2023, more than three years after the declarations initially took effect.

On the date the emergency declarations end (May 11, 2023), employer sponsored group health plans will no longer be required to cover out-of-network COVID-19 vaccinations, in-network or out-of-network COVID-19 diagnostic testing or related services, or over-the-counter COVID-19 tests without participant cost-sharing. This means group health plans may apply deductibles, copayments, or coinsurance for these services. However, in-network COVID-19 vaccinations must continue to be covered without participant cost-sharing under the Affordable Care Act’s preventive care mandate.

In addition, 60 days after the date the emergency declarations end (July 10, 2023), multiple extended deadlines will expire and revert to their length prior to the emergency declarations.  These include:

  • For group health plans, the deadlines for participants to request special enrollment and to elect and pay for COBRA continuation coverage.
  • For all ERISA governed plans – including group health plans, other welfare plans, and retirement plans – the deadlines for participants to file benefit claims and appeals.
  • For plan sponsors and fiduciaries, the deadlines to provide plan related notices (e.g., summary plan descriptions, summaries of material modifications, and summary annual reports).

In anticipation of these changes, plan sponsors may wish to:

  • Review their current plan design and determine whether any mid-year changes will be made upon the expiration of the emergency declarations;
  • Communicate such changes, as well as the expiration of the extended participant deadlines, to participants; and/or
  • Update their plan documentation and communications to reflect these changes.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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