The COVID-19 pandemic—and resulting declaration of national and state emergencies—continues to have an impact on health plans and commercial insurance coverage.
Recently, federal regulators temporarily suspended limits on timelines that commercial members and employer groups must normally adhere to for certain types of actions. This suspension is in place to ensure that individuals who might have missed key deadlines during the COVID-19 outbreak will not have a loss or lapse of their group health coverage or a denial of a valid claim for benefits.
What deadlines are affected by timeline suspension?
This federal guidance affects certain deadlines for:
- COBRA continuation coverage
- Special enrollment periods
- External review of certain claims
It also includes benefit claims and denial appeals for disability, retirement and other plans.
How the timeline suspension works
For each of the affected timelines, the clock stopped running on March 1, 2020, and will not restart until 60 days after the declared national emergency ends—whenever that turns out to be. The days within that time period will not be counted toward the timeline.
More specifically, the federal guidance suspends certain timelines for:
- Notifying the health plan of a qualifying life event or determination of disability.
- Making enrollment changes off-anniversary due to a qualifying event. This must usually be done within 30 days of the event. (In some cases, for example if an employee lost MassHealth coverage, this may be a 60-day timeline.)
- Notification, election and initial payment for COBRA, such as:
- 60-day election period for COBRA continuation coverage.
- The date for making COBRA premium payments.
- Submitting a claim for benefits.
- Filing an internal or external appeal, including appeals of an adverse benefit determination.
Examples
Here are a few examples of how this may affect health plan members:
- Members normally have 180 days to file an internal appeal. If a member was notified of a claim denial 80 days before March 1 of this year, the new guidance will give them until 160 days after the national emergency ends to file an appeal—that is, 60 days after the emergency ends, plus the 100 days they had remaining as of March 1.
- If a member was notified of a claim denial on May 4, 2020, they will have until 240 days after the national emergency ends to file an appeal—60 days after the emergency ends, plus the 180 days they would normally have.
- If an employee’s hours are reduced during the national emergency and the employee was provided a COBRA election notice on April 1, 2020, they can elect COBRA coverage up to 60 days after the end of the national emergency.
Your Account Manager can provide more information if you have questions.
