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DOL Employee Benefits Security Administration and IRS Guidance

PBA is continually working on your behalf to modify administrative procedures to adapt to this quickly evolving legislative and regulatory environment during the COVID-19 national emergency.

During the last several weeks, the Department of Labor’s Employee Benefits Security Administration and the Internal Revenue Service have been issuing guidance to provide temporary flexibility and relief to group health plans and cafeteria plans, as well as to clarify legislation enacted by Congress. The highlights of some of the recent changes affecting group health plans is provided below.

Even though the relief is welcomed by many, the administrative challenge to implement these changes is complex. Most of these changes will be handled by PBA and/or your FSA or COBRA administrator.

If you have not already done so, please contact me if you are amending your Section 125 salary reduction plan and would like to permit mid elections to the group health plan or if you have any questions. Other changes outlined below may be administered under a Plan’s “Conformity With Law” provision given the temporary characteristic of the regulations.

COVID-19 Testing and Related Services

Legislation enacted by Congress requires group health plans, including qualified high deductible health plans (HDHPs), to provide benefits in full for COVID-19 testing (no copays or member cost-sharing). Required coverage has been clarified to include:

  • COVID-19 testing, even if not FDA-approved. This includes serological tests for COVID-19 used to detect antibodies.
  • Diagnostic services and items provided during urgent care, emergency room, or in-person or telehealth provider visits that result in an order for or administration of COVID-19 testing. This includes blood tests and x-rays administered to rule out flu or pneumonia.
  • When available, COVID-19 preventive items, services, and immunizations that receive specified recommendations from the CDC’s United States Preventive Services Task Force.

There is currently no requirement under federal law to cover treatment of COVID-19 without cost sharing.

Mid-Year Election Change Relief

Numerous Plan deadlines that occur during the COVID “outbreak period” have been extended. The outbreak period began on March 1, 2020 and ends 60 days after the announced end of the National Emergency declaration. This period is to be disregarded for the following purposes:

  • HIPAA Special Enrollment Periods (for group health plans, other than retiree only plans)
    • Loss of eligibility for other health plan coverage
    • Acquiring a dependent through marriage, birth, adoption, or placement for adoption
    • Eligibility for premium assistance under Medicaid or a state Child Health Insurance Plan (CHIP) or loss of Medicaid or CHIP eligibility
    • The initial 60-day election period for COBRA continuation coverage
    • The date for making COBRA premium payments
    • The date for an individual to notify a Plan of a qualifying event or determination of disability
  • Claim Deadlines
    • The date within which individuals may file a benefit claim (other than Dependent Care FSAs, unless an onsite day care)
    • The date within which claimants may file an appeal of an adverse benefit determination
    • For Non-Grandfathered Health Plans - the date within which claimants may file a request for an external review or provide additional information to complete the request
  • Furnishing Notices
    Plan Administrators will not be treated as having violated notice requirements if they act in good faith and furnish any notices, disclosures, or documents that would otherwise have to be furnished during the outbreak period (including those requested in writing by a participant or beneficiary) “as soon as administratively practicable under the circumstances.” Good faith acts include use of electronic alternative means of communicating with plan participants and beneficiaries who the Plan Administrator reasonably believes have effective access to electronic means of communication, including email, text messages, and continuous access websites.

Although this relief may be welcome due to disruptions that have occurred, there are many questions that are pending further direction. For example, the duration of the COVID-19 pandemic is uncertain and may vary in different parts of the country.

PBA is continuing to monitor developments and will keep you informed as further guidance is issued and sample notices are developed.