This just in….

On May 4, 2020, The Department of Labor (DOL), the Department of the Treasury, and the Internal Revenue Service issued the final ruling, linked here final ruling that “extend[s] certain timeframes otherwise applicable to group health plans, disability and other welfare plans, pension plans, and their participants and beneficiaries under ERISA and the Code.”

This email focuses solely on changes and extensions made to the timeframes for participants to exercise rights pertaining to certain medical and disability claims and appeals of denied claims.

 Key Take Away: Administrators will be expected to extend the time for claimants to file a claim, or appeal a claim, and must disregard days during the “Outbreak Period.” “Outbreak period” means fromMarch 1, 2020 until 60 days following the announced end of the COVID-19 national emergency.”

How do you comply with these temporary rule changes? Examples are provided, below.   

NOTE: For purposes of these examples, below, an assumed end date for the National Emergency was needed to make the examples clear and understandable. Accordingly, the Examples assume that the National Emergency ends on April 30, 2020, with the Outbreak Period ending on June 29, 2020 (the 60th day after the end of the National Emergency). To the extent there are different Outbreak Period end dates for different parts of the country, the Agencies will issue additional guidance regarding the application of the relief in this document.

EXAMPLE:  Extended time for claims for medical treatment under a group plan.  Participant “is a participant in a group health plan. On March 1, 2020, Individual D received medical treatment for a condition covered under the plan, but a claim relating to the medical treatment was not submitted until April 1, 2021. Under the plan, claims must be submitted within 365 days of the participant’s receipt of the medical treatment. Was Individual D’s claim timely? (ii) Conclusion. Yes. For purposes of determining the 365-day period applicable to Individual D’s claim, the Outbreak Period is disregarded. Therefore, Individual D’s last day to submit a claim is 365 days after June 29, 2020, which is June 29, 2021, so Individual D’s claim was timely.”

 EXAMPLE:  Extended time for filing an internal appeal— disability plan. Claimant “received a notification of an adverse benefit determination from Individual E’s disability plan on January 28, 2020. The notification advised Individual E that there are 180 days within which to file an appeal. What is Individual E’s appeal deadline? (ii) Conclusion. When determining the 180-day period within which Individual E’s appeal must be filed, the Outbreak Period is disregarded. Therefore, Individual E’s last day to submit an appeal is 148 days (180-32 days) following January 28 to March 1) after June 29, 2020, which is November 24, 2020.”