QUESTION: As required, our group health plan has extended the length of HIPAA special enrollment periods due to the COVID-19 emergency. When do the extended special enrollment periods end?
ANSWER: In response to the COVID-19 emergency, the DOL and IRS extended HIPAA special enrollment period deadlines by requiring plans to disregard (for a maximum of one year) the COVID-19 “outbreak period,” which began March 1, 2020, and is set to end on July 10, 2023. As background, 30-day special enrollment periods may be triggered when eligible employees or dependents lose eligibility for other health plan coverage, or when an eligible employee acquires a dependent through birth, marriage, adoption, or placement for adoption. 60-day special enrollment periods may be triggered by changes in eligibility for Medicaid or state premium assistance under the Children’s Health Insurance Program (CHIP). (While state agencies generally did not terminate individuals’ Medicaid or CHIP coverage during the COVID-19 emergency, program eligibility determinations could resume after the “continuous enrollment condition” ended on March 31, 2023—see our Checkpoint article.)
For purposes of the extended deadlines, initial agency guidance stated that the outbreak period would end 60 days after the announced end of the COVID-19 national emergency or such other date as announced by the agencies (see our Checkpoint article). Although the national emergency ended on April 10, 2023 (see our Checkpoint article), the DOL later announced informally that, consistent with the agencies’ March 2023 FAQs, the outbreak period will end on July 10, 2023. As of that date, extensions will no longer be required for HIPAA special enrollment periods. For example, an individual who gives birth to a child before the end of the outbreak period has until August 9, 2023 (30 days after the July 10 end of the outbreak period), to exercise special enrollment rights, regardless of whether the birth occurred before or after the end of the national emergency. But an individual who gives birth after July 10 will have 30 days after the date of the birth to exercise special enrollment rights. Likewise, employees who lost Medicaid or CHIP coverage from March 31, 2023, through the end of the outbreak period will have until September 8, 2023 (60 days after the July 10 end of the outbreak period), to request plan enrollment, while those losing coverage after July 10 will have the usual 60 days from the loss of coverage.
The agencies encourage group health plans to allow for longer special enrollment periods to ease the transition to normal timeframes. For more information, see EBIA’s HIPAA Portability, Privacy & Security manual at Section X (“Special Enrollment Rights”) and EBIA’s Self-Insured Health Plans manual at Section XVI.C.4 (“Special Enrollment Periods Required Under HIPAA”).
Contributing Editors: EBIA Staff.