America's Benefit Specialist May 2023

THE END OF COVID EMERGENCIES

ers whose stand-alone telehealth plan has a plan year that is the same as the calendar year, the plan should terminate on or before December 31, 2024. EXTENSION OF DEADLINES During the national emergency, the time period for individu als to take certain plan-related actions is tolled or suspended for one year or until 60 days after the emergency is lifted, whichever is earlier. That tolling rule is difficult to understand in the abstract but becomes clearer with examples. Example One: Alice is enrolled in her employer’s major medical plan. On January 15, 2022, she goes to the doctor. Under the terms of the plan, Alice must submit her claim within six months of the date the care was received. Because of the tolling rule, however, Alice’s six-month clock does not begin to run until January 15, 2023. Alice must submit her claim by July 15, 2023. Example Two: Brad is enrolled in his employer’s major medical plan. On October 15, 2022, he goes to the doctor. Un der the terms of the plan, Brad must submit his claim within six months of the date the care was received. Because of the tolling rule, however, Brad’s six-month clock does not begin to run until July 10, 2023 (60 days after the emergencies are lifted, assuming they are lifted on May 11). Brad must submit his claim by January 10, 2024. The time periods affected by the tolling rule are those for: • electing COBRA coverage and making COBRA premium payments • notifying the plan of a COBRA-qualifying event • notifying the plan of a disability in order to obtain an ex tension of the COBRA coverage period • submitting claims and appeals • requesting (and providing information for) external re views of claims or appeals • requesting special enrollment

Most employers will not have to calculate the tolling peri ods or the new deadlines. For example, the time period for submitting claims and appeals is typically calculated by an insurance company or third-party administrator. Similarly, the time period to elect COBRA coverage or make a COBRA premium payment is typically calculated by a third-party CO BRA administrator. However, because employees are likely to ask for assistance in navigating their health benefits, it is important for employers and benefits specialists to under stand the basics of the tolling rule. TWO FINAL NOTES This article does not discuss the entire universe of possible consequences of lifting the emergencies. Remember that change can happen quickly. Things might have shifted between the time this article was written and the time you are reading it! 1 “Major medical plan” is an industry term and not a legal term. For purposes of this article, it means full-service medical plans. It does not include vision or dental plans. It does not include grandfathered plans, preventive-care-only plans, or other “skin ny” plans. 2 The Employee Retirement Income Security Act (ERISA) does not cover government plans or church plans. The rules for those plans are similar to the rules described in this article, but I have not attempted to identify the gaps and variations. 3 For these purposes, a “large employer” means an employer that employed an average of at least 51 employees on business days during the preceding calendar year and that employs at least two employees on the first day of the plan year.

Juliana Reno is a partner at Venable and chair of its Employee Benefits and Executive Compensation Practice Group.

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