COVID-19 Relief and Guidance for Employee Benefit Plans: Understanding Extended Deadlines
On May 4, the Department of Labor, Treasury Department and Internal Revenue Service issued joint rulings that extend various deadlines during the COVID-19 state of emergency.
According to the DOL, EBSA Disaster Relief Notice 2020-01, “extends certain time frames affecting participants’ rights to healthcare coverage, portability, and continuation of group health plan coverage under COBRA, and extends the time for plan participants to file or perfect benefit claims or appeals of denied claims. These extensions provide participants and beneficiaries of employee benefit plans additional time to make important health coverage and other decisions affecting their benefits during the coronavirus outbreak.”
There are two guidances that may affect your employer sponsored Difference Card plan:
1. Claim Run Out
Normally, participants have until the end of the claim run out period to submit claims for the prior year. Under the new guidance, any claim run out ending AFTER February 29, 2020 has been extended to 60 days after the declaration of the national emergency.
For example: Employee A has a plan that ended on November 30, which means the claim run out ended on February 29, 2020. Under the new guidance, there is no change to Employee A’s claim run out period. However, if Employee A was enrolled in a plan ending on December 31 and the claim run out for 2019 expenses normally ended on March 31, 2020, then that deadline how now been extended for an additional 60 days after the end of the national emergency is declared.
2. Appeals
Normally, participants have 180 days to submit an appeal upon receiving notice of an adverse benefit decision when they receive a claim denial letter. That timeframe is now extended to 60 days until after the end of the national emergency.
For example: Employee B received a claim denial letter on October 1, 2019. Under ERISA, Employee B would normally have 180 days or until March 28, 2020 to submit an appeal. That deadline is now extended through 60 days until after the end of the federal emergency.
HELPFUL RESOURCES:
COVID-19 FAQs for Participants and Beneficiaries
U.S. DEPARTMENT OF LABOR ISSUES COVID-19 RELIEF AND GUIDANCE FOR EMPLOYEE BENEFIT PLANS
Key Takeaways
- El 4 de mayo, el Departamento de Trabajo, el Departamento del Tesoro y el IRS emitieron dictámenes conjuntos (incluyendo EBSA Disaster Relief Notice 2020-01) que extienden varios plazos durante la emergencia nacional por COVID-19.
- Las extensiones afectan los derechos de los participantes a la cobertura sanitaria, la portabilidad y la continuación de la cobertura grupal bajo COBRA, y el tiempo para presentar o perfeccionar reclamaciones de beneficios o apelaciones de denegaciones.
- Claim run-out: cualquier periodo de presentación de reclamaciones (claim run-out) que termine DESPUÉS del 29 de febrero de 2020 se extiende hasta 60 días después del fin de la emergencia nacional; si el run-out terminó el 29 de febrero no cambia, pero un run-out previsto para el 31 de marzo de 2020 sí se extiende.
- Apelaciones: el plazo habitual de 180 días para presentar una apelación tras una denegación se extiende y queda suspendido hasta 60 días después del fin de la emergencia federal (ejemplo: una denegación del 1 de octubre de 2019 cuya fecha límite habría sido el 28 de marzo de 2020 queda extendida).
- Se proporcionan recursos útiles (FAQ del DOL, comunicado del DOL y publicación en el Federal Register) y la entrada del blog está fechada el 20 de mayo de 2020 por The Difference Card.
