Summary of Recent Federal Rules and Guidance Related to Certain Group Health Plans Due to National Emergency

June 5, 2020

The federal government released new rules and guidance related to employer-sponsored group benefit plans in response to COVID-19. Below is a summary of key elements of the April 29, 2020, guidance from the U.S. Department of Labor and U.S. Treasury Department.

Although the guidance is primarily directed at benefit plans themselves and the employers that sponsor them, Blue Cross and Blue Shield of Oklahoma (BCBSOK) is working through the operational details of the guidance to assist employers that are seeking to implement it. BCBSOK will continue to provide more information in the future as appropriate.

The April 29 guidance temporarily suspends certain deadlines for members and participants related to COBRA and claims, appeals and external reviews during a period of time that the guidance describes as the “Outbreak Period” for the following: 

• Fully insured plans
• ERISA self-insured plans
• Church plans

Group plans should consult their own legal advisors as to the application of this guidance to their benefit plans, but BCBSOK anticipates that group plans will administer any plans within the scope of the guidance in a manner consistent with its requirements.

Duration: According to the guidance, the Outbreak Period began at the start of the National Emergency (March 1, 2020) and ends 60 days after the National Emergency is declared over, or some other date determined by the federal government, not to exceed one year.  

The guidance addresses the following topics:

Plan Documentation Requirements. The guidance provides compliance relief to ERISA group health plans around certain timeframes for providing documents to participants such as SPDs, claims procedure extension and denial notices; for responding to requests for plan documents from participants; and for filing 5500 and M-1 forms with the government.

Special Enrollment. During the Outbreak Period, impacted plans cannot apply deadlines (typically, 30 days, or 60 days in some cases) for certain HIPAA special enrollment requests. This means that plans may need to retroactively provide eligible employees or dependents with coverage once elected.

COBRA Administration. During the Outbreak Period, the guidance:

• Suspends the 14-day deadline (or, the 44-day deadline when employer is plan administrator) for the plan administrator to provide COBRA election notices to qualified beneficiaries (QB). The original deadline will begin to run again once the Outbreak Period is over. 
• Suspends the following deadlines:
  • 45-day deadline for individuals to make initial premium payment;
  • 30-day deadline for subsequent premium payments;
  • 60-day deadline for individuals to elect COBRA; and
  • 60-day deadline for QBs to provide notice of certain qualifying events (e.g., divorce or legal separation) or disability determination.

Note: Self-insured customers may need to collaborate with their stop-loss carriers to understand and address potential coverage issues. 

Claims and Appeals, and External Reviews. During the Outbreak Period, the guidance does not suspend deadlines for ERISA plans to adjudicate claims and appeals. However, it does suspend the following:

• The deadline by which participants can file a benefit claim (under terms of plan);
• The 180-day deadline for appealing adverse benefit determinations (ABDs);
• The four-month (for federal external review process) period for claimant to file a request for external review (the period could be different for state external review process); and,
• The four-month (or 48-hours following receipt of an incomplete request notification, if later) period for the claimant to perfect an incomplete request for external review.

Generally, any remaining time periods to satisfy the deadlines, which are temporarily suspended by the guidance, will begin to run again at the end of the applicable Outbreak Period.