National Emergency and Public Health Emergency declarations ending: How does this impact health plans?

Apr 12, 2023

The Biden Administration recently ended the COVID-19 National Emergency Declaration on April 10, 2023, and announced that it will end the Public Health Emergency Declaration on May 11, 2023. These declarations were implemented in 2020 and impacted plan sponsors, health plans, insurers and state-run programs. Just as there were significant impacts when the NE and PHE were put into place, it’s important to prepare for the impact the ending of these declarations will have. 

Here’s how the end of the National and Public Health Emergencies will impact health plans: what you need to know.

1. COVID-19 Diagnostic Testing without Cost Sharing  

Following April 10, 2023, non-grandfathered group health plans and issuers will no longer be required to provide COVID-19 tests and related services without cost sharing, prior authorization or other medical management requirements.  

2. COVID-19 Vaccines 

During the PHE, non-grandfathered health plans and issuers were required to cover recommended COVID-19 immunizations and preventive services without cost sharing both in-network and out-of-network. After the end of the PHE, health plans and issuers will be required to continue providing recommended COVID-19 vaccinations without cost sharing but can limit the coverage to in-network providers.  

3. Standalone Telehealth Benefits 

For plan years beginning January 1, 2022, large employers may offer standalone telehealth benefits and other remote care services to individuals who are not eligible for coverage under any other health plan without violating the Affordable Care Act market reforms. These standalone arrangements will no longer be permitted after the PHE ends on May 11, 2023.

4. High Deductible Health Plans (HDHP) Telehealth or Remote Services 

With the passing of the Consolidated Appropriations Act of 2023, HDHPs will be permitted to provide benefits for telehealth or other remote services before meeting plan deductibles without jeopardizing HSA eligibility for plan years beginning in 2023 and 2024.

5. Extended Deadlines Expire 

The Outbreak Period (OP) expires on June 9, 2023, 60 days after the end of the National Emergency on April 10, 2023. With the end of the NE and the expiration of the OP, deadlines that were not counted during the OP will default to the timeframes outlined in the relevant plan documents and statutes. Deadlines that were tolled during the Outbreak Period will re-align to pre-pandemic rates on June 9, 2023. These include:

  • The 14-day deadline for plan administrators to provide COBRA election notices to qualified beneficiaries
  • The 30-day period (or 60-day period, if applicable) to request special enrollment 
  • The 60-day election period for COBRA continuation coverage 
  • The date for making COBRA premium payments
  • The date for individuals to notify the plan of a qualifying event or determination of disability 
  • The date within which individuals may file a benefits 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

With this upcoming change, we encourage all plan sponsors to take proactive measures by reviewing plan documents, procedures, policies, COBRA notices and other employee communications to ensure they align with the pre-pandemic rules. 

For more information or to connect with a Totem team member to discuss what these changes may mean for you, contact us.

Sources: Federal Register: Extension of Certain Timeframes for Employee Benefit Plans, Participants, and Beneficiaries Affected by the COVID-19 Outbreak; How the End of the National and Public Health Emergencies Will Impact Health Plans | Leavitt Group News & Publications


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