The ERISA statute and regulations include guidelines for timing of certain acts that employers need to perform, as well as deadlines for employees. For example, when employment or group health insurance coverage ends, employers are obligated to give notice to employees and affected beneficiaries of their right to elect continuation of their health insurance. Employees and beneficiaries then have 60 days to elect such coverage, or to elect substitute coverage when COBRA ends without having to wait for the annual enrollment period. In addition, when benefit claims are denied, employees have the right to appeal denials within certain time frames specified in the ERISA claim regulations depending on the nature of the claim (health benefits, disability benefits, retirement benefits, and other types of benefits). Due to the disruptions caused by the COVID-19 pandemic, however, the Employee Benefits Security Administration, which is part of the U.S. Department of Labor, along with the Internal Revenue Service and the Department of the Treasury, extended deadlines due to the national emergency. Let’s discuss the Covid-19 impact on ERISA employee benefits deadlines.
Covid-Related Extensions of ERISA Deadlines
On May 4, 2020, notice was published in the Federal Register extending ERISA deadlines pursuant to a national emergency declaration issued by the federal government on March 13, 2020. The extensions affected the following benefits:
Health Insurance Portability and Accountability Act (HIPAA) – Since the passage of the Affordable Care Act, which eliminated health insurers’ ability to exclude pre-existing conditions from coverage, the HIPAA law has declined in importance. However, the national emergency deadline extension has allowed individuals to go from one health plan to another with creditable coverage beyond the 60-day requirement.
COBRA – The COBRA law allows individuals who lose their health insurance coverage under a group plan a period of 60 days to elect to continue their coverage retroactive to the date the coverage ended. The COVID-19 national emergency proclamation has extended that time frame.
Claims Procedures – Dates for applying for benefits and for appealing benefit denials have also been extended, along with an extension of the time frame provided under the Affordable Care Act to seek an independent external review after a health benefit claim has been denied and appealed unsuccessfully.
More information about COVID-19 related extensions may be found in EBSA Disaster Relief Notice 2020-01. Although the initial extension extended all due dates until 60 days following the end of the national emergency, a subsequent notification from the Department of Labor, EBSA Disaster Relief Notice 2021-01 limited the extension. The latter notice explained:
Individuals and plans with timeframes that are subject to the relief under the Notices will have the applicable periods under the Notices disregarded until the earlier of (a) 1 year from the date they were first eligible for relief, or (b) 60 days after the announced end of the National Emergency (the end of the Outbreak Period). On the applicable date, the timeframes for individuals and plans with periods that were previously disregarded under the Notices will resume. In no case will a disregarded period exceed 1 year.
The national emergency remains ongoing. The current administration has extended the national emergency until March 1, 2023.
What Are the Implications of the COVID-19 National Emergency Declaration
For those who were eligible for COBRA continuation of their health insurance benefits and failed to make an election within the 60 days specified in the notices they received, there may yet be time to apply for benefits. Or if COBRA coverage has ended, there may still be an opportunity to elect coverage under an ACA-marketplace plan outside of the normal annual enrollment period.
The biggest impact of the COVID-19 related extension, though, may be with respect to benefit claims and appeals of benefit claim denials. If you were denied a benefit under a disability, life, or health insurance plan, there may still be time to appeal even if you missed the deadline set forth in the denial letter so long as you are within one year from the date an appeal was due.
If you find yourself in such a situation, you should immediately contact a benefits attorney who is knowledgeable and experienced in benefits claim issues who can assist you in determining whether you can still appeal.