The Centers for Medicare & Medicaid Services (CMS) has issued a Temporary Period of Relaxed Enforcement of certain time frames related to group market requirements under the Public Health Service Act in Response to the COVID-19 Outbreak. This temporary relaxed enforcement is in accordance with guidance recently issued by the Internal Revenue Service (IRS) and the Department of Labor (DOL).
The IRS and DOL notice required group health plans, disability and other employee welfare benefit plans, and employee pension benefit plans subject to ERISA or the Code to disregard the period from March 1, 2020 until 60 days after the announced end of the National Emergency or such other date announced by the Agencies in a future notice (the “Outbreak Period”) dates for the 30-day period (or 60-day period, if applicable) to request special enrollment under ERISA and the Code. The notice extended the deadlines for notifications COBRA continuation of coverage, HIPAA special enrollment periods, claims for benefits, appeals of denied claims, and external review of certain claims. SPBA had a webinar on this new notice and it is available on demand on the SPBA website
CMS being in concurrance with the policies issued by IRS and DOL, will adopt a temporary policy of relaxed enforcement to extend similar time frames 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 and beneficiaries. Under this temporary policy, CMS also will not consider a Small Business Health Options Program (SHOP), a SHOP issuer offering a qualified health plan (QHP) through a SHOP, or small business participating in a SHOP to be out of compliance with rules applicable to the SHOP, to the extent the SHOP, issuer, or small business operates in a manner consistent with this relief. This extension of time frames is not mandatory for non-Federal governmental plans. However, CMS does encourage plan sponsors of non-Federal governmental plans to provide relief to participants and beneficiaries similar to that specified in the above referenced joint notice from the IRS and DOL. CMS also encourages, but does not require, states, SHOPs, and health insurance issuers offering coverage in connection with a group health plan to enforce and operate, respectively, in a manner consistent with the relief provided in the Joint Federal Register Noticeand EBSA Notice 2020-01. The relief provided by the bulletin does not apply to health insurance issuers offering individual health insurance coverage.
The extension of time frames noted the IRS and DOL notices are:
- the 30-day period (or 60-day period, if applicable) to request special enrollment under ERISA and the Code.
- the 60-day election period for COBRA continuation coverage under ERISA and the Code.
- the date for making COBRA premium payments.
- the date for individuals to notify the plan of a qualifying event or determination of disability under ERISA section 606(a)(3).
- the date within which individuals may file a benefit claim under the plan’s claims procedure.
- the date within which claimants may file an appeal of an adverse benefit determination under the plan’s claims procedure.
- the date within which claimants may file a request for an external review after receipt of an adverse benefit determination or final internal adverse benefit determination.
- the date within which a claimant may file information to perfect a request for external review upon a finding that the request was not complete.
