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Extended Benefit Claims & Appeals Periods During COVID-19

In response to the COVID-19 pandemic, federal agencies have extended certain claims and appeals periods for employee pension benefits plans subject to the Employee Retirement Income Security Act of 1974 (ERISA). The relief also applies to qualifying group health plans, as well as eligible disability plans and other employee welfare benefit plans.

The extension permits the ‘outbreak period’ — which began March 1, 2020 and will conclude 60 days after the announced end of the COVID-19 emergency — to be disregarded for specified purposes related to claims. Read on for further details.

Pertinent Deadlines

Affected timeframes include the deadlines for individuals to:

  • Notify the plan of a qualifying event or determination of disability
  • File claims for benefits
  • File appeals of adverse benefit determinations under ERISA plans and non-grandfathered group health plans

Deadlines also have been extended for requesting external review following exhaustion of the plan’s internal appeals procedures. Other deadlines that apply for perfecting an incomplete request for review are extended as well.

Illustrative Examples

For instance, if the COVID-19 national emergency had ended on April 30, 2020 the disregarded outbreak period would have ended 60 days later, on June 29. Thus, if an employee received medical treatment on March 1, 2020, but did not submit a claim relating to the treatment until April 1, 2021, and the plan required that claims be submitted within 365 days of receipt of treatment, this participant’s request would be considered timely submitted.

To determine the 365-day period applicable to the claim, the outbreak period is disregarded. Therefore, the last day to submit a claim under this example is 365 days after June 29, 2020, which is June 29, 2021.

Also, based on the same assumptions, let’s say an individual received a notification of an adverse benefit determination from his or her disability plan on January 28, 2020, which notified him that there were 180 days within which to file an appeal. In such a case, the employee’s appeal deadline would be determined by disregarding the outbreak period. Therefore, the last day to submit the appeal would be 148 days after June 29, 2020 — 180 less 32 days elapsed from January 28 to March 1 — which would be November 24, 2020.

More Information

Although plans are not expressly granted more time to process and decide claims, the U.S. Department of Labor recognizes that the COVID-19 emergency may present challenges for plans in achieving ‘full and timely compliance’ with ERISA’s claims procedure requirements. The agency said that its approach to enforcement will emphasize compliance assistance and may include other relief.

If your organization sponsors an ERISA plan — be it a pension, health plan, or some other type of welfare benefit plan — explore the ramifications of this extension carefully. Our firm can provide more information and keep you updated on further developments about COVID-19-related relief.

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