The White House has announced their intent to renew the COVID-19 public health emergency and national emergency one last time and have both emergencies expire May 11, 2023. This is in the spirit of providing at least 60 days advance notice so government programs, health care providers, and health plans have ample time to make adjustments. While this is just an expression of intent and not the official announcement, there is every expectation that stakeholders nationwide can rely on this expressed intent and start planning accordingly.
Assuming May 11 is the official last day of these emergencies, here is the impact to health plans:
- Starting May 12, all health plans would no longer be required to cover COVID-19 tests and related services, including over-the-counter tests, without cost-sharing
- Should plans choose to voluntarily continue to cover these tests, they could begin to impose prior authorization requirements, medical management techniques, and/or cost-sharing as of May 12
- High deductible health plans (HDHPs) with health savings accounts (HSAs) would need to begin applying the deductible to these services if they remain covered
- Note if these services are reflected on the plan’s Summary of Benefits and Coverage (SBC), a change mid-plan year requires 60 days advance notice
- Starting May 12, non-grandfathered health plans would no longer be required to cover COVID-19 vaccines and boosters out-of-network without cost-sharing
- However, vaccines and boosters remain part of the required preventive care coverage requirement, so non-grandfathered plans would still have to cover them in-network without cost-sharing
- Note if these services are reflected on the plan’s Summary of Benefits and Coverage (SBC), a change mid-plan year requires 60 days advance notice
- The federal “outbreak period” (which extended deadlines for COBRA notices and payments, HIPAA special enrollments, and ERISA claims and appeals) will come to a close 60 days after the announced end date (May 11 plus 60 days means the outbreak period would end July 10, 2023)
- So starting July 11, 2023, deadlines under the provisions above which have been delayed under outbreak period relief would resume
- For example, anyone who became eligible for COBRA between July 11, 2022, and July 10, 2023, would have their usual 60-day COBRA election window begin on July 11, 2023, giving them 60 days through September 8, 2023, to submit their elections
- Similarly, COBRA payment due dates and grace periods would also resume as of July 11, 2023
We do expect an official announcement and formal guidance to help guide all stakeholders through this transition. For example, we expect plans will need to notify employees of changes to coverage and cost-sharing, but it’s not yet clear whether a special notice will be required with respect to COBRA election and payment deadlines.
IMA will continue to monitor regulator guidance and offer meaningful, practical, timely information.
This material should not be considered as a substitute for legal, tax and/or actuarial advice. Contact the appropriate professional counsel for such matters. These materials are not exhaustive and are subject to possible changes in applicable laws, rules, and regulations and their interpretations.