The U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) and the U.S. Internal Revenue Service (IRS) have published a Joint Notice, guidance, and FAQ extending certain Employee Retirement Income Security Act (ERISA) deadlines due to the COVID-19 outbreak. The Joint Notice extends participant filing deadlines for employee benefit plans, including disability plans, group health plans, and other welfare and pension plans. Deadline extensions apply during the “Outbreak Period,” defined in the Joint Notice as between March 1, 2020, the beginning of the national emergency declared by the President, until 60 days after the announcement of the end of the COVID-19 National Emergency or such other date announced by the U.S. Department of Labor. End dates could vary across the United States if different parts of the country have different Outbreak Period end dates.
ERISA-governed disability plans must modify claims procedures with these deadline extensions claims procedures, which include a claimant’s ability to file or perfect a claim for benefits or appeal a denial of benefits. The Joint Notice states that all ERISA-governed group health plans, disability, and other employee welfare pension plans must disregard the Outbreak Period when calculating claim procedure deadlines.
For disability plans, this means that claimants’ time period in which to file a claim for benefits, perfect the claim, or file for an appeal due to a denial of disability benefits is extended by the number of days in the Outbreak Period.
The Joint Notice provides examples. Example 6 pertains to a disability plan appeal deadline by disregarding the Outbreak period during the 180–day appeal deadline calculation. The example assumes that the National Emergency ends on April 30, 2020, with the Outbreak Period ending on June 29, 2020 (60 days after April 30):
Example 6 (Internal appeal—disability plan). (i) Facts. Individual E 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.
Carriers and employers should remain updated on EBSA’s and IRS’s guidance in order to follow the Outbreak period deadline extension calculation. FINEOS partners with its customers to remain compliant with ERISA claims procedures.
Used by over 50 insurance organizations in the Life, Accident and Health industry, FINEOS Claims is recognized as the best-in-class, web-based claims processing software solution. FINEOS Claims supports group, voluntary and individual claims on a the FINEOS Platform, powered by AWS, and can be deployed by carriers of all sizes.
