Rules, Requirements, and Deadlines Changed Due to COVID-19
Group health insurance plan administrators in Colorado know that the intersection of COVID-19 and employee health benefits has brought about a plethora of participant questions and many new challenges.
Existing rules, deadlines, and legal requirements for Colorado health insurance administrators and covered employees that made sense pre-coronavirus may now create logistical and coverage problems. Also, with mandatory business shutdowns, some employers have changed or dropped certain employee coverage to save money.
As a result, the federal government recently issued guidance and modified several rules to provide more flexibility and protect workers from losing their coverage.
Agencies Announce Modifications for COVID-19 and Employee Health Insurance Benefits
On May 4th, 2020, the Internal Revenue Service (IRS) and the Employee Benefits Security Administration (EBSA) announced the extension of certain timeframes and deadlines for group health plans under the Employee Retirement Income Security Act (ERISA) and the Internal Revenue Code. In the announcement, the IRS and EBSA noted that because of the national emergency caused by COVID-19, “participants and beneficiaries covered by group health plans…may encounter problems in exercising their health coverage portability and continuation coverage rights, or in filing or perfecting their benefit claims.” Similarly, the agencies recognized that “affected group health plans may have difficulty in complying with certain notice obligations” because of the pandemic and the ensuing upheaval in employment. As such, the agencies decided to “take steps to minimize the possibility of individuals losing benefits because of a failure to comply with certain pre-established timeframes.”
COVID -19 Employee Health Insurance Benefits Update: Protection of Participant Portability and Continuation Rights
To protect the portability of Colorado employer-provided medical insurance coverage, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that plans provide a special enrollment period in certain designated circumstances. These circumstances include an employee’s or dependent’s loss of eligibility for a group health plan or other health insurance coverage in which they were previously enrolled. Employers must also provide a special enrollment period when a covered employee needs to add a dependent due to birth, marriage, adoption, or placement for adoption.
Generally, Colorado group health plans must allow such employees to enroll in the group health plan if they are otherwise eligible, and if the individual requests enrollment within 30 days of the occurrence of the qualifying event.
Now, due to COVID-19, all group health plans must disregard the period from March 1st, 2020 until 60 days after the announced end of the National Emergency declared on March 13th, 2020, or any other date designated by the agencies (the “Outbreak Period”) when calculating the 30-day period for requesting special enrollment.
COBRA Continuation Coverage
Qualified health plan beneficiaries generally have at least 60 days to elect COBRA continuation coverage under a group health plan. Plans cannot require payment of premiums earlier than 45 days after the day of the employee’s initial COBRA election. The law also establishes periods within which plans must notify qualified beneficiaries of their right to elect COBRA continuation coverage, and employers must notify the plan of certain qualifying events.
As with special enrollment periods, administrators should not count the time between March 1st and the declared end of the Outbreak Period when calculating the 60-day election period for COBRA continuation coverage or the date for making COBRA premium payments.
Extension of Time For Benefits Claims
Health insurance plans will also disregard the Outbreak Period when determining the date within which individuals may file benefits claims under the plan’s claims procedure, as well as the date within which claimants may appeal an adverse benefit determination.
Reach Out to Us With Questions About COVID-19 and Employee Health Benefits
We know that these are unsettling and uncertain times. At Preferred Insurance, an experienced Colorado Springs business health insurance broker, we remain available to answer your questions and deliver solutions that can keep you and your workforce safe and healthy. We are locally owned and operated and can provide free quotes in less than 48 hours.
Contact Preferred Insurance to schedule a free consultation about your small business health insurance needs.