In the world of insurance, remaining informed and adaptable is crucial. The COVID-19 pandemic has brought about unprecedented shifts in regulations and deadlines, requiring businesses to stay nimble. Among these changes is the latest update regarding HIPAA Special Enrollment, a matter we at Brookshire Benefits are keen to help you navigate effectively.
The Story Thus Far
In response to the COVID-19 National Emergency, the Department of Labor (DOL) and Treasury issued guidance which required benefit plans to extend certain Employee Retirement Income Security Act (ERISA) deadlines. These included extensions related to COBRA continuation coverage, HIPAA special enrollment, and benefit claims and appeals, which took effect from March 1, 2020. The deadline extensions were originally set to expire on the earlier of July 10, 2023, or one year from the date an individual first became eligible for the extension.
The Latest Development
As detailed in a joint letter from the Centers for Medicare & Medicaid Services (CMS), Treasury, and DOL on July 20, 2023, the Biden-Harris Administration is now requesting employers and plan sponsors to amend their group health plans. The objective? To extend the 60-day special enrollment period mandated by HIPAA for individuals who are losing Medicaid and Children’s Health Insurance Program (CHIP) coverage.
This extension aims to coincide with the temporary special enrollment period on HealthCare.gov, which runs from March 31, 2023, to July 31, 2024. The goal is to ensure continuity of health coverage for the millions of individuals expected to lose Medicaid and CHIP coverage since the continuous enrollment provision concluded on March 31, 2023.
Five Key Considerations for Plan Sponsors
While the request from the Biden-Harris administration is clear, it’s important to understand the possible courses of action and their implications. Here are five key points:
- Option to Extend Special Enrollment Period: Plan sponsors are not required to extend their group health plan’s 60-day special enrollment period for the loss of Medicaid and CHIP.
- Alternatives to Extending the Special Enrollment Period: If a plan sponsor chooses not to extend the 60-day special enrollment window, they can take other steps to aid employees in securing health coverage. These steps can include providing timely reminders about the 60-day enrollment window, Medicaid and CHIP renewal, and suggesting enrollment in coverage via the HealthCare.gov exchange. Useful resources for employers have been provided by CMS here.
- Plan Amendments for Special Enrollment Period Extension: Plan sponsors opting to extend the special enrollment period should amend their plan and/or issue a summary of modification (SMM), clarifying the terms of the special enrollment period. This action will help prevent adverse selection and ensure compliance with cafeteria plan rules prohibiting retroactive mid-year election changes.
- Approvals for Plan Changes: It’s always crucial for self-funded plans to secure approval for any changes from their stop-loss carrier, and insured plans from their insurer.
- Notification and Education: After deciding on a course of action, plan sponsors should inform participants and educate their benefits department. This step will facilitate a uniform administration of special enrollment.
At Brookshire Benefits, we understand that these regulatory shifts and the evolving landscape of employee health coverage can be complex. Rest assured, we’re committed to guiding our clients and their employees through these changes and helping you make the most informed decisions possible. If you have any questions or need further information, don’t hesitate to reach out to our team.
