Based on DOL FAQ guidance and subsequent commentary, the COVID-19 National Emergency Outbreak Period ended on July 10, 2023. This means that the tolling of certain ERISA plan deadlines (e.g., COBRA elections, payments and certain notices, HIPAA special enrollments, and claims and appeals filings) will no longer be required.

Now that the COVID-19 National Emergency has ended, employers must prepare for the end of the Outbreak Period. Based on DOL FAQ guidance and subsequent commentary, the Outbreak Period will end on July 10, 2023. This means that the tolling of certain ERISA plan deadlines (e.g., COBRA elections, payments and certain notices, HIPAA special enrollments, and claims and appeals filings) will no longer be required.

The ACA imposed the PCOR fee on health plans to support clinical effectiveness research. The PCOR fee applies to plan years ending on or after October 1, 2012, and before October 1, 2029. The PCOR fee is generally due by July 31 of the calendar year following the close of the plan year.

Under the CAA, Section 204, insured and self-insured group health plans are required to report significant information regarding prescription drug and healthcare spending to the government. The 2020 and 2021 calendar year data submissions are due by December 27, 2022. However, under recently announced relief, a submission grace period is available to employers who make a good faith submission of the 2020 and 2021 data on or before January 31, 2023.

Annually, large employers must report the aggregate cost of group health coverage provided to employees on Form W-2. The coverage must be reported on a calendar-year basis, regardless of the ERISA plan year or policy year. The reporting is intended for informational purposes for employees.

Effective for plan years beginning on or after January 1, 2023, the Transparency in Coverage Final Rule (TiC) requires most group health plans and carriers to make personalized out-of-pocket cost information available to participants through an internet-based self-service tool or in paper format (upon request). The self-service tool is designed to provide participants with real-time, accurate estimates of their cost-sharing liability for healthcare items and services from different providers prior to receiving care.

On July 1, 2022, enforcement of the machine-readable file requirement of the Transparency in Coverage (TiC) final rule begins. Under the rule, non-grandfathered group health plans and insurers must publicly post machine-readable files that disclose in-network provider negotiated rates and historical out-of-network allowed amounts and billed charges for plan years beginning on or after January 1, 2022. (Enforcement of the prescription drug rate file requirement is postponed pending regulatory review.)

As a reminder, employers who sponsor a group health plan that provides prescription drug coverage to Medicare Part D eligible individuals must disclose to CMS, on an annual basis, whether the coverage qualifies as creditable or non-creditable. The disclosure is due no later than 60 days after the beginning of each plan year. Thus, for calendar year plans, the disclosure is due March 1, 2022.

Employers that were applicable large employers (ALEs) in 2021 and sponsored group health plans (whether insured or self-insured) must comply with IRC Section 6056 reporting in early 2022. Specifically, ALEs must complete and distribute Form 1095-C to full-time employees by March 2, 2022 (changed from January 31, 2022). The form should detail whether the employee was offered minimum value, affordable coverage during 2021. The forms may be mailed, electronically delivered or delivered by hand (although proof of delivery in some manner is recommended).

On October 15, 2021, the DOL updated its Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) model notice that employers with group health plans may use to notify eligible employees about premium assistance available through their state Medicaid or CHIP. The DOL regularly updates the notice to reflect any changes to the list of states offering premium assistance programs.