The Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS) has followed the guidance, jointly issued by the U.S. Departments of Labor and the Treasury, that extends benefits-related deadlines in the face of COVID-19 hardships affecting plans and plan participants. That guidance provides for relaxed enforcement of requirements for plans to furnish notices, disclosures, and documents under ERISA as long as the plans act in good faith to comply as soon as practicable. The guidance also extends deadlines for participants to make certain elections, provide certain notices under group health plans, and to file claims and appeals under any ERISA plan.

In its own guidance, CMS concurs with the DOL/Treasury guidance and states that it would also relax its enforcement efforts with regard to applicable deadlines. Although the guidance encourages plans to extend deadlines for participants to make special enrollment elections, make elections and payments and provide certain notices under COBRA, and file ERISA plan claims and appeals, the guidance stops short of actually requiring state and local government plans to offer these extensions.

Additionally, CMS encourages states, entities participating in the Small Business Health Options Program (SHOP), and health insurance issuers offering coverage in connection with group health plans generally to operate in a manner consistent with the DOL/Treasury guidance—but does not require it.

The relief offered by the CMS guidance does not apply to insurers offering products in the individual health insurance market.

Ballard Spahr’s Employee Benefits and Executive Compensation attorneys can assist health insurance issuers and non-federal governmental plan sponsors to adopt the changes consistent with the CMS guidance.