COBRA election, special enrollment periods, and claims and appeals deadlines
Tufts Health Plan is taking measures to allow for the extended deadlines affecting COBRA continuation coverage, special enrollment periods, claims for benefits, appeals of denied claims, and external review of certain claims.
According to the federal guidance, the national emergency due to the COVID-19 outbreak began on March 1, 2020. At that point, timelines associated with COBRA, making enrollment changes due to special enrollment rights, submitting and appealing claims, and external claims review were paused. Pursuant to the EBSA Disaster Relief Notice, those timelines will resume the earlier of (a) one-year from the date which you were first eligible for relief under the federal guidance, or (b) the end of the Outbreak Period (which is 60 days after the end of the COVID-19 National Emergency). The federal government has not yet announced the end of the National Emergency.
Additionally, IRS Notice 2021-58 clarifies how these federal extensions impact COBRA premium payments given that qualified beneficiaries have 60 days to elect COBRA after receipt of a COBRA election notice and COBRA premiums are due 45 days following that initial COBRA election (105 days total), with a 30-day grace period. This IRS Notice provides the following example:
IRS Example #3:
(i) Facts. Individual C participates in Employer Z’s group health plan. Individual C has a qualifying event and is provided a COBRA election notice on August 1, 2020. When must Individual C elect COBRA continuation coverage and, if Individual C elects COBRA continuation coverage, when must Individual C make the initial COBRA premium payment?
(ii) Conclusion. Individual C has until September 30, 2021 (one year and 60 days after August 1, 2020) to elect COBRA continuation coverage. If Individual C elects COBRA continuation coverage after September 30, 2020 (but on or before September 30, 2021) Individual C has until November 14, 2021 to make the initial COBRA premium payment (one year and 105 days after receipt of the election notice). If Individual C makes the initial COBRA premium payment on November 14, 2021, that premium payment would include the monthly premiums for August 2020 through October 2020. The November 2020 monthly COBRA premium payment would be due by December 1, 2021 (one year and 30 days after November 1, 2020), with premium payments due every month after that for the months Individual C is eligible for COBRA continuation coverage.
Employers should consult with their attorneys to determine the appropriate timing requirements and COBRA compliance under their plans. See Tufts Health Plan ’s FAQ above under “COBRA premium assistance (American Rescue Plan)” for information on how these federal deadline extensions interact with the American Rescue Plan’s COBRA rules.