Another HIPAA Special Enrollment Deadline Extension – What’s a Group Health Plan to Do?

Allison B. Bans • July 31, 2023

Just when you thought the confusing COVID-19 ERISA deadline extensions were behind you, the Biden-Harris Administration asks you to reconsider. 

Recap – In response to the COVID-19 National Emergency, DOL and Treasury issued guidance requiring benefit plans to extend certain ERISA deadlines related to COBRA continuation coverage, HIPAA special enrollment, and benefit claims and appeals, effective March 1, 2020.  These deadline extensions generally expired on the earlier of: (1) July 10, 2023; and (2) one year from the date an individual first became eligible for the extension.   

Update – As noted in the CMS, Treasury, and DOL July 20, 2023 letter , the Biden-Harris Administration is calling on employers and plan sponsors to amend their group health plans to extend the 60-day special enrollment period required by HIPAA for individuals losing Medicaid and CHIP and ideally match the temporary special enrollment period on HealthCare.gov that runs from March 31, 2023 – July 31, 2024.  During the COVID-19 Public Health Emergency, Medicaid programs had to keep people continuously enrolled to receive enhanced federal funding.  Because this continuous enrollment provision ended March 31, 2023, millions of individuals are going to lose Medicaid and CHIP coverage.  Furthermore, because HHS estimates 3.8 million of these individuals will be eligible for employer sponsored coverage, the Biden-Harris Administration wants group health plans to help their employees maintain health coverage.

Five Considerations –

  1. A plan sponsor does not have to extend its group health plan’s 60-day special enrollment period for loss of Medicaid and CHIP. 

  1. If a plan sponsor decides not to extend this 60-day special enrollment window, it can take other steps to help its employees obtain health coverage such as telling them they can enroll in the group health plan within 60 days, reminding them about Medicaid and CHIP renewal, and encouraging them to enroll in coverage through the Exchange on HealthCare.gov.  CMS has provided an employer fact sheet for employers available here and a compilation of other resources here.

  1. If a plan sponsor decides to extend its 60-day special enrollment period for loss of Medicaid and CHIP, it should amend its plan and/or issue a summary of modification (“SMM”) clarifying the terms of the special enrollment period.   For example, employers seeking to avoid adverse selection and to comply with the cafeteria plan rules that generally prohibit retroactive mid-year election changes should clarify that enrollment will be prospective and set an end date for the extended enrollment period.

  1. As always, self-funded plans should seek approval of any changes from their stop-loss carrier, and insured plans from their insurer.

  1. Once a plan sponsor makes a decision, it should notify participants and educate its benefits department so they can administer special enrollment on a uniform basis. 

Employee burnout: what it is and how to prevent it

By Mardy Gould • May 24, 2024
Employee burnout has become an epidemic in today’s modern workplace. So much so that the World Health Organization (WHO) officially recognizes it as an “occupational phenomenon.”1 While many used to consider mounting workplace stress an individual employee problem, these days, it’s become an employer’s responsibility to prevent burnout before it hurts productivity and business performance—not to mention your employees’ physical and mental health. Luckily, you can prevent burnout from affecting your workforce in several ways. This article will explore the causes and signs of employee burnout and the steps you can take to create a positive work environment where employees feel safe from toxic stress levels.

Form 720 and PCORI fee FAQs

By Mardy Gould • May 23, 2024
If you're a small business owner, you may have heard of the acronym PCORI and the fees that come with it. But what is PCORI, and how does it apply to your organization? Under the Affordable Care Act (ACA), sponsors of self-insured health plans must pay a fee to fund the federal Patient-Centered Outcomes Research Institute (PCORI). PCORI is an independent organization the ACA created to conduct research to help healthcare consumers make better decisions for their specific needs and outcomes. It also performs research related to clinical effectiveness. Employers offering a self-insured medical reimbursement health plan, such as a health reimbursement arrangement (HRA), must pay this fee by July 31 each year via Form 7201. This fee was initially set to expire in 2019, but Congress extended it through September 30, 20292, due to the Further Consolidated Appropriations Act of 20203.
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