GPAHU Pulse – May 2020

GPAHU - Monthly State and Legislative Updates

Seventy-seven percent of the workforce wants to continue working from home at least weekly even after stay-at-home orders are lifted, according to the Global Workplace Analytics Survey. That’s a 132 percent increase over those who wanted to work from home before coronavirus. Source: Global Workplace Analytics Survey Data, Spring 2020

Trump Administration Makes Significant Changes to COBRA and Other Group Plan Deadlines

The Department of Labor issued Disaster Relief Notice 2020-01, and also issued an emergency rule jointly with the Internal Revenue Service that makes significant deadline changes that apply to almost all employer-sponsored health insurance plans. The changes are retroactive back to March 1, 2020, and last until up to 60 days following the end of the COVID-19 national emergency, as determined by the Trump Administration (called the “Outbreak Period”). These deadline changes impact COBRA, special enrollment periods, claims deadlines, and other critical aspects of group health plan administration, so it is important that they are understood by health insurance agents and brokers.

COBRA Changes: Effective March 1, group health plans subject to federal COBRA requirements cannot consider a person’s COBRA election period deadline if it occurs during the Outbreak Period. Regardless of when a person’s election period starts or should end under standard COBRA rules, if their election period falls within the Outbreak Period, they now have until 60 days after the expiration of the COVID-19 emergency period to elect COBRA continuation coverage. These group plans must also disregard the Outbreak Period concerning the payment of COBRA premiums.  Once the national emergency period is over, COBRA recipients will have 30 days to make all payments.  If they cannot make the required payment, their coverage may be retroactively terminated or limited to the months for which they did make payment. The regulation also gives employers until after the end of the national emergency period to deliver COBRA election notices.

HIPAA Special Election Periods: Employer group health plans subject to HIPAA must disregard special election request deadlines for the duration of the Outbreak Period. Typically, an employee must request enrollment within 30 or 60 days, depending on the qualifying event.  Now employees have the entire Outbreak Period plus the standard amount of time to make an election.

Disability Election Period: The regulation establishes that employers cannot consider the Outbreak Period regarding the deadline to notify the group plan about a qualifying event or determination of disability.

Claims and Appeals Deadlines: During the Outbreak Period, the deadlines plan participants usually have regarding filing claims, appeals, requests for external review, and requests to perfect an external review do not apply. However, deadlines for the plan administrator to decide claims or appeals remain the same.

DOL Notice 2020-01 expands upon the group health plan deadline relief. It clarifies that group plans that need to postpone plan document distribution deadlines during the COVID-19 outbreak do not violate ERISA, provided they act in good faith. However, it also makes it clear that employers need to issue required documents and notices as practical. Plan administrators have a fiduciary duty to provide for both the group plan and its participants. The notice allows employers to use reasonable electronic alternative means of communicating with plan participants during the coronavirus outbreak period.  Alternative means may include email, text messages, and continuous access websites.

PAHU Sends PA Exchange Letter Concerning Broker Policies

The Pennsylvania Health Insurance Exchange Authority Board has been meeting monthly to move forward with the implementation of the state-based exchange for the 2021 individual market open enrollment period.  A number of the issues under consideration by the board would have an impact on brokers, including the timing of the release of rates and commission data for brokers for the 2021 open enrollment season and appointment and certification requirements for producers who want to sell exchange-based products.  The Pennsylvania Association of Health Underwriters recently sent a letter to the Exchange Authority concerning the role of agents and brokers with the new state-based exchange, which addresses some of these critical issues. Click here to read the letter.

PA Exchange Authority Seeks Broker Input

Insurance Commissioner Jessica Altman sent a letter to Pennsylvania’s Congressional delegation recommending federal actions to help provide stability and affordability to the insurance market for consumers and insurers. Some of the things she suggests include:

  • A federal reinsurance program to cover high-cost claims related to COVID-19 and insurer rate stability as insurers attempt to forecast for 2021
  • Federal funding to pay for the cost of a vaccine or other treatments developed in the future, to help prevent these possible costs from being priced into 2021 premium rates
  • Advance premium tax credit flexibility to account for income fluctuations due to layoffs additional unemployment compensation
  • Addressing the “Family Glitch” in the ACA that prevents families from qualifying for premium tax credits
  • Subsidizing COBRA premiums until the end of the current plan year
  • A federal exchange special enrollment period for uninsured individuals and those whose employer coverage plan does not align with marketplace coverage
  • Balance billing legislation to protect consumers from surprise medical bills

Check This Out!

If you want to expand your health policy knowledge beyond this newsletter, here is a resource to check out!

The Department of Labor developed a webpage and guidance specifically to provide information to workers and employers about a multitude of return-to-work issues related to stay-at-home orders and the coronavirus pandemic.

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