America's Benefit Specialist May 2023

THE END OF THE COVID EMERGENCIES AND THE ISSUES FACING MAJOR MEDICAL PLANS

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By Juliana Reno Partner, Venable LLP New York, NY jreno@venable.com

When the pandemic hit, the United States government scrambled to minimize the damage. President Trump declared a national emergency under the Stafford Act. The Department of Health and Human Services declared a public health emergency under the Public Health Services Act. Congress passed not one, but four laws. The administrative agencies issued guidance relaxing some existing rules and imposing some new obligations. EMPLOYERS WILL HAVE TO DECIDE WHETHER THEIR PLANS WILL COVER COVID VACCINES FROM OUT-OF NETWORK PROVIDERS.

After approximately three years, President Biden an nounced his intention to lift these emergency declarations as of May 11. Lifting the emergencies will trigger a new wave of changes in the legal landscape. In many instances, the legal changes will require action or at least a decision. This article discusses the most significant actions and decisions that will need to be addressed by employers whose major medical plans1 are subject to ERISA. 2 In some cases, particularly but not exclusively in the case of a small employer with a fully insured plan, the issues will not be addressed by the employer but by the insurance company or another entity providing services to the plan. For ease of discussion, this article assumes that the employer is the decision maker. COVID BENEFITS Vaccines: For the duration of the public health emergency, plans must cover COVID vaccines at no cost to the individual,

6 ABS | benefitspecialistmagazine.com