Employer Considerations in the Wake of the End of Several Important COVID-19 Requirements

May 4, 2023
Michael Bivona
EB   Senior Services   Educational Materials


Many employment and health insurance-related mandates were implemented due to the COVID-19 pandemic. The pandemic’s waning influence on our everyday life has allowed lawmakers to relax restrictions and regulations surrounding it. The federal government has decided that many of the COVID-era restrictions on group health plans, such as the Public Health Emergency (PHE) that was declared in 2020, will come to an end in 2023.


As we have previously reported, certain mandates ended on April 11, 2023. Other COVID-19 mandates are due to end on May 11, 2023 with the end of the PHE:


- Employer health plans will no longer be required to cover COVID-19 diagnostic tests (either prescription or over the counter); and


- Employer health plans will no longer be required to cover out-of-network COVID-19 vaccinations.


The following will still be in effect after the May 11, 2023 deadlines:


- In-network coverage for COVID-19 vaccinations must continue without cost-sharing (including the Rapid Coverage requirement); and


- Personal Protective Equipment (PPE) will still be considered a qualified medical expense under FSA and HRA regulations.


Transition from the Outbreak Period


Employer health plans should be aware that the May 11 is when the Outbreak Period is officially over. Many notice requirements that had been suspended during the Public Health Emergency will be reinstated sixty days after the end of the Outbreak Period (per legislation).


The following requirements will have their time periods “unfrozen” sixty days from the end of the Outbreak Period (July 10, 2023). As such, employer health plans will now have to return to the standard notice timetables:


- The 30-day period (or 60-day period for CHIP and Medicaid beneficiaries) to request HIPAA special enrollment.


- The 60-day election period for COBRA continuation coverage.


- The date for making COBRA premium payments (the 45-day grace period for the initial payment and the 30-day grace period for subsequent monthly payments).


- The date for individuals to notify a plan of a COBRA qualifying event or determination of disability.


- The date by which individuals may file a benefit claim under a plan’s claims procedure (applicable to both health and welfare plans and retirement plans covered by ERISA or the Code).


- The date by which claimants may file an appeal of an adverse benefit determination under the plan’s claims procedure (applicable to both health and welfare plans and retirement plans covered by ERISA or the Code).


- The date by which claimants may file a request for an external review after receipt of certain group health plan adverse benefit determinations or final internal adverse benefit determinations.


- The date by which a claimant may file information to perfect a request for external review upon a finding that the request was not complete.


- Furnishing COBRA election notices.


Employer Notice of Changes


Employer health plans would normally be required to provide at least 60 days’ notice for any material modification of an employee’s health benefits. However, the federal government has made an exception for the end of COVID-19 mandates as a result of the end of the Public Health Emergency:


- An employer will be considered to have satisfied the notice requirement for material modifications if they have either previously notified the employee in the current plan year of the duration of the COVID-19 benefits or provide notice within a reasonable time period before the benefits expire.


As such, employers should notify their employees as soon as possible if any benefits granted by the COVID-19 mandates are due to end on May 11, 2023.


What Else Employers Can Do


Employers may have several other obligations regarding the end of the Outbreak Period. If an employer determines that certain benefits towards their employees are changing after May 11, 2023, they should do the following:


- Ensure that all benefits that are affected by the end of the PHE are re-distributed to the employees and clearly articulated. This includes all appropriate deadlines;


- Inform affected employees of whether any action is needed on their part to maintain current benefits;


- Ensure that all suspended health plan notice procedures are followed again after July 10, 2023; and


- Update all plan documents to remove any mention of COVID-19 or pandemic extensions related to diagnostic testing and out-of-network vaccinations.


You can read the entire FAQ HERE.


Heather Reynolds, ESQ

CCO - Administrative Officer
FNA Insurance Services, Inc.
516-348-7199 |[email protected]

Michael Bivona

Compliance Paralegal
FNA Insurance Services, Inc.
516-348-7135 |[email protected]