What does the end of the Covid-19 Public Health Emergency mean for employers?

Recently, President Biden declared that the COVID-19 Public Health Emergency and which has been in effect since March 2020, will come to an end on May 11, 2023. The related National Emergency ended on April 10, after a bipartisan congressional resolution was signed to bring it to a close after three years — weeks before it was set to expire alongside the separate Public Health Emergency. This marks the start of a crucial phase in the continuing pandemic, as well as the conclusion of a sequence of benefits facilitated by these emergencies. 

As an employer, it’s important to be aware that certain policies that were implemented in response to the Public Health Emergency will soon come to an end. It’s possible that these changes may impact the health coverage of you and your employees. 

So, what are the specific implications of terminating the PHE and National Emergency for employers and their health and benefits programs? Furthermore, how should they approach and plan for this change?

As the end of the COVID-19 Public Health Emergency draws near, what steps should employers take to prepare?

First and foremost, it’s important to recognize that the conclusion of the COVID-19 public health emergency has prompted many employers and other plan sponsors to reassess their health benefits offerings. For example, plans will no longer be required to provide coverage for certain COVID-19-related services at no cost to the participant, but may still choose to do so. Additionally, certain flexibilities that allowed for extensions of timeframes related to certain health plan deadlines (such as special enrollment, COBRA election and payment, and claims and appeals deadlines) may soon expire.

As we move forward into the next phase of the COVID-19 experience, effective communication with participants and employees is crucial. It’s essential to inform them about any changes to their health benefits. It’s also important to outline any new benefits that will be introduced, as well as the deadlines by which participants and their families must make key health-related decisions. Answering these questions is essential to ensure that workers and their families are well-informed and equipped to make the right choices regarding their health coverage.

Furthermore, it’s worth noting that some of your employees and their family members may have previously opted out of your health plan due to their eligibility for Medicaid or the Children’s Health Insurance Program (CHIP), but may now be losing that eligibility. As a result, they may be entitled to special enrollment opportunities to join their employer-sponsored health coverage.

Things that employers should pay attention to once the COVID-19 Public Health Emergency ends

• Health plans coverage: Once the COVID-19 public health emergency ends, group health plans will no longer be obligated to provide coverage for COVID-19 diagnostic testing at zero cost to individuals. However, it’s recommended that plans continue to offer coverage for these tests without charging out-of-pocket expenses, given the ongoing importance of testing in mitigating the spread of COVID-19. If plans intend to modify their COVID-19 testing coverage (or other benefits), it’s essential to inform individuals about these changes and any significant limitations well in advance of the changes taking effect.
• Group health plans will no longer be obliged to cover “qualifying coronavirus preventive services” provided by out-of-network providers without cost sharing, including vaccines, after the COVID-19 public health emergency ends. Although many plans will still be required to cover COVID-19 vaccines provided by in-network providers at no cost to employees, the obligation to cover vaccines obtained from out-of-network providers will generally expire with the conclusion of the COVID-19 public health emergency. If plans are altering their coverage for COVID-19-related preventive services, it’s crucial to inform individuals about these changes and any significant restrictions beforehand.
• Employee benefit plans: Certain timeframes for employee benefit plans are expected to end on July 10, 2023, which is 60 days after the end of the national emergency. These extensions provided individuals with more time to take necessary actions such as electing COBRA continuation coverage, paying COBRA premiums, submitting health plan claims and appeals, and requesting special enrollment to join their employment-based health plan. To prevent individuals from losing their benefits due to missed deadlines, employers should evaluate the need to modify their plan deadlines. It is crucial to inform the individuals affected by these changes of the new deadlines in advance.
• Telehealth services: Numerous health plans have broadened their telehealth offerings in response to the public health emergency caused by COVID-19. After the COVID-19 public health emergency ends, employers cannot offer stand-alone telehealth and remote care service arrangements to employees or their dependents who are not eligible for other employer group health plan coverage, without violating certain ACA market reform rules.
• Medicaid and CHIP coverage: After March 31, 2023, employees and dependents currently enrolled in Medicaid or CHIP coverage may lose their eligibility. Over the past three years, enrollment in the government healthcare program has increased significantly due to COVID-19 rules that prevented states from terminating beneficiaries during a public emergency. As the emergency period ends, it is anticipated that numerous individuals, among the millions currently covered by Medicaid, will lose their eligibility and consequently be excluded from the program. 

As a result, some of them may enroll in their employers’ health plans, leading to an increase in enrollment and, consequently, a rise in claims and premium costs. While state Medicaid agencies have not terminated coverage for any beneficiary who was covered at any time on or after March 18, 2020, many states are now starting to unwind this “continuous enrollment” and resume eligibility determinations. This could lead to some of your employees or their dependents losing their coverage. To address this, employers should inform employees who may be affected, about their special enrollment rights to enroll in the group health plan. Employers are also encouraged to adjust their plans to provide more time for individuals to exercise their special enrollment rights and ensure that they can maintain health coverage.

The following steps are suggested for employers to prepare for the conclusion of pandemic emergencies

• Evaluate health plan conditions concerning COVID-19-related coverage
• Assess temporary pandemic relief laws and the benefits offered under them
• Seek support and advice from third-party administrators and insurers
• Inform employees about the impact of the national emergency and PHE ending
• Ensure employees are informed about changes to special enrollment conditions.

Employers can receive valuable guidance on preparing for the end of pandemic emergencies by referring to the recently published Frequently Asked Questions (FAQ) by the DOL, U.S. Department of Health and Human Services, and the U.S. Department of the Treasury. This guidance offers insights on various topics, including COVID-19 testing, vaccine coverage, extended COBRA deadlines, special enrollments, and claims and appeals related to group health plans.

End of National Emergency/Outbreak Period: Implications for Employers 

Beginning July 11, 2023, the time restrictions for HIPAA Special Enrollment will return to a 30-day (or 60-day if applicable) period for requesting midyear enrollment in a group health plan. Similarly, specific deadlines for COBRA will revert to their standard requirements, such as the 60-day window to elect COBRA continuation coverage, the time frames for making COBRA premium payments, the period to notify the plan of qualifying events or disability determination, and the timeline for plan sponsors to provide COBRA election notices. 

Additionally, deadlines for claims and appeals under all plans governed by ERISA, including both retirement and welfare plans, will also return to their pre-pandemic timing. Included in this are the cutoff dates for submitting benefit claims, appealing an adverse benefit determination, requesting an external review after receiving an adverse benefit determination or final internal adverse benefit determination, and providing information to complete a request for external review.

These transitions can be complicated. If you have questions or need help with your health coverage, please contact our team of experts. VantagePoint is dedicated to collaborating with employers, plan sponsors, participants, and other stakeholders to guarantee a smooth and secure shift away from the COVID-19 public health emergency period.