Mandatory Extension of Certain Deadlines for Health Benefit Plans Due to Recent Natural Disasters

Overview

Mandatory Extension of Certain Deadlines for Health Benefit Plans Due to Recent Natural Disasters. 

Employer Action Items

• Employers directly affected by many of the recent natural disasters should determine if they are, in fact, in a designated disaster area by looking at the website maintained by the Federal Management Agency (“FEMA”), which has the specified information on identified counties and areas.
• Also, employers should consider whether their employees were impacted and give affected employees additional time to take certain actions related to COBRA continuation, special enrollment periods, and claims for benefits (Note: the notice provides examples to illustrate the time frame for extensions required under the notice, which may prove helpful to review). 
• Employers should work with their third-party vendors (including COBRA administrators) and benefit administration system providers to see how this relief will be implemented and should take steps to amend their plan documents accordingly.
• Non-federal governmental plans should consider whether they will provide this relief to participants, beneficiaries, enrollees, qualified beneficiaries, and claimants, as encouraged by the Centers for Medicare & Medicaid Services (“CMS”).

Summary

On November 8, 2024, the Departments provided deadline relief for employee benefit plans (covered by Title I of ERISA or the IRC), participants, beneficiaries, and claimants in disaster areas affected by Hurricane Helene, Tropical Storm Helene, and Hurricane Milton.  The relief offered under the notice was provided effective immediately. 

With respect to plan participants, beneficiaries, qualified beneficiaries, or claimants directly affected by Hurricane Helene, Tropical Storm Helene, or Hurricane Milton, the relief extends:

• HIPAA time frames: The 30- or 60-day period to request special enrollment.
• COBRA time frames: The 60-day period to elect COBRA coverage, make premium payments, and notify the plan of qualifying events or disabilities.
• Claims procedures time frames: Deadlines for filing benefit claims and appeals.
• External review process time frames: Deadlines for requesting and perfecting external reviews.

For group health plans, including their sponsors and administrators, that are subject to ERISA or the IRC, the relief period is disregarded when determining the date for providing a COBRA election notice.

A participant, beneficiary, qualified beneficiary, or claimant is directly affected if they resided, lived, or worked in a disaster area at the time of the disaster, or if their coverage was under an employee benefit plan that was directly affected. 

Disaster areas are those areas designated as eligible for individual assistance by FEMA due to a particular storm. 

An employee benefit plan is directly affected if it’s principal place of business was located in one of the disaster areas at the time of the hurricane or tropical storm. This designation also applies if the plan’s primary recordkeeper or administrator has an office located in a designated disaster area.

The relief is required, rather than elective. Also, available relief extends the previously mentioned time frames through May 1, 2025. As such, time frames for compliance with deadlines are suspended during this period. 

The Centers for Medicare & Medicaid Services (“CMS”) encourages non-federal governmental plans and health insurance issuers to provide similar relief (see https://www.cms.gov/files/document/hurricane-helene-disaster-relief-bulletin.pdf). In addition, CMS will not penalize these entities for delayed notices or documents if they act in good faith and use electronic communication when feasible.

Additional Information & Related Resources

• Joint Notice:  https://www.federalregister.gov/documents/2024/11/08/2024-26014/extension-of-certain-timeframes-for-employee-benefit-plans-participants-beneficiaries-qualified.
• EBSA Resources: The Employee Benefits Security Administration provides additional resources on its disaster relief information webpage, including FAQs for participants and beneficiaries:  https://www.dol.gov/agencies/ebsa/employers-and-advisers/plan-administration-and-compliance/disaster-relief.
• FEMA Resources: FEMA’s Website with disaster areas: https://www.fema.gov/disaster/current.

If you have additional questions, or if you need assistance applying these mandates, please do not hesitate to reach out to the Baldwin Group. We are available to provide additional guidance and practical resources for clients looking to navigate these requirements.