On January 30, 2023 the Biden Administration announced that both the National Health Emergency and the HHS Public Health Emergency will end on May 11, 2023.  

The news came in the form of a statement of administration policy typically issued in response to legislation dealing with emergency declarations. The statement reads: “The COVID-19 national emergency and public health emergency (PHE) were declared by the Trump Administration in 2020. They are currently set to expire on March 1, 2023 and April 11, 2023, respectively. At present, the Administration’s plan is to extend the emergency declarations to May 11, 2023 and then end both emergencies on that date.”

The COVID-19 Public Health Emergency

The HHS public health emergency was separate from the COVID-19 national emergency. The public health emergency is declared and periodically renewed by the Secretary of Health and Human Services. The public health emergency required that health plans cover COVID-19 testing, COVID-19 vaccinations, and any item, service, or immunization intended to prevent or mitigate COVID-19, at 100% without member cost sharing.  

Beginning May 11, 2023, plans can begin charging member cost sharing for COVID-19 testing, including at-home COVID-19 testing. However, COVID-19 vaccinations must continue to be covered at 100% based on ACA preventive services guidelines – but only at the in-network level. If a plan sponsor wants to maintain 100% plan coverage for COVID-19 tests and testing, an additional amendment will need to be adopted. Without such an amendment, COVID-19 testing claims will be paid in the same manner as similar tests such as those detecting the flu virus.

The COVID-19 National Emergency

The COVID-19 national emergency was declared by the President and required that health plans disregard the statutory election periods for COBRA coverage and special enrollment periods, as well as claim filing and external review deadlines during the “Outbreak Period.” This allowed plan participants extra time to make elections, pay for COBRA coverage, or submit claims without penalty or exclusion.  

As of July 10, 2023, plan-related time frames and deadlines for the types of events covered by the national emergency go back to normal with no extensions provided. However, plan members who are in the middle of a COVID-19 national emergency deadline extension will get to run-out the period of time dictated by such extension, as modified by the termination of the national emergency.

Because each individual’s situation is different, the national emergency doesn’t end on a specific date for all plan members. Any individual taking advantage of such a deadline extension prior to July 10, 2023 will be given time to run out that extension opportunity. The Outbreak Period ends, for any applicable event, on the earlier of one (1) year from the date that the relief was first available for an individual or the end of the Outbreak Period, which is July 10, 2023.

The examples below illustrate how certain current extensions afforded plan participants under the COVID-19 national emergency should be handled due to the end of the Outbreak Period.

Mary was sent a COBRA election notice on July 1, 2022. Due to the Outbreak Period, the 60 day election period was tolled (i.e., put on hold during the national emergency). The Outbreak Period for Mary’s election period will end June 30, 2023. That date is the earlier of one year from the original election notice date (July 1, 2022) or July 10, 2023. That means that the plan starts the COBRA election notice 60-day time period on July 1, 2023. Remember, the member is still required to pay any COBRA premium back to the original COBRA effective date (in this case July 1, 2022).

Sara receives services from a provider on February 1, 2022. Her plan requires all claims to be filed within one (1) year of the date the service was provided. But due to the Outbreak Period, her claim filing period was tolled. The Outbreak Period with respect to Sara’s claim filing period ended January 31, 2023. Thus, her 1-year period to file her claim began February 1, 2023 (the earlier of February 1, 2023 or July 10, 2023. Sara has until January 31, 2024 to file her claim.

Lucy delivered a baby on November 1, 2022, but failed to enroll the newborn on the plan within the special enrollment period of 30 days. Due to the Outbreak Period, the 30 day special enrollment period was tolled. The Outbreak Period with respect to Lucy’s baby ended July 10, 2023 which is the earlier of July 10, 2023 or November 1, 2023. Lucy has until August 9, 2023 to enroll the baby on the plan.

MedBen is preparing amendments to plan documents addressing the end of the COVID-19 emergency periods so that plan members will have prior notice of these changes. If you determine that you would like to continue to pay a COVID-19 related services at a higher level of benefits, please contact your Account Manager as an additional amendment will be needed. If you have any questions, please contact Caroline Fraker or Erin Kelly.