CARES ACT & DEPENDENT VERIFICATION

[CEB]

Hello, can you provide me with some guidance on the "relaxed deadlines" in the "out-break period" when an employee fails to verify their dependents. The dependent was removed from the plan in May.  But they are now providing documentation and asking for reinstatement. Under normal circumstances we do not allow the dependent to be re-enrolled until Open Enrollment. 

[Brian Gilmore]

The Outbreak Period extensions (now capped at a disregarded period of one year) apply to HIPAA special enrollment, COBRA (elections, notices, and payment), claims submission deadlines, appeal deadlines, and external review deadlines.  They don't apply to a dependent audit documentation situation.

However, if this was a mid-year enrollment based on a HIPAA special enrolment event (e.g., loss of other coverage or birth, adoption, or placement for adoption), and it's still within one year of that event, the Outbreak Period would apply.  In other words, if the employee attempted to enroll the child based on the HIPAA special enrollment event that occurred within the past year but failed to provide the required documentation for enrollment (e.g., proof of loss of other coverage, birth certificate), the employee would still have the extended one-year window (or, if earlier, until the end of the Outbreak Period) to complete the special enrollment.

Here's the relevant section of the "Joint Notice":

https://www.federalregister.gov/documents/2020/05/04/2020-09399/extension-of-certain-timeframes-for-employee-benefit-plans-participants-and-beneficiaries-affected

III. Relief

A. Relief for Plan Participants, Beneficiaries, Qualified Beneficiaries, and Claimants

Subject to the statutory duration limitation in ERISA section 518 and Code section 7508A,[7] all group health plans, disability and other employee welfare benefit plans, and employee pension benefit plans subject to ERISA or the Code must disregard the period from March 1, 2020 until sixty (60) days after the announced end of the National Emergency or such other date announced by the Agencies in a future notification (the “Outbreak Period”) [8] for all plan participants, beneficiaries, qualified beneficiaries, or claimants wherever located in determining the following periods and dates—

(1) The 30-day period (or 60-day period, if applicable) to request special enrollment under ERISA section 701(f) and Code section 9801(f),Start Printed Page 26354

(2) The 60-day election period for COBRA continuation coverage under ERISA section 605 and Code section 4980B(f)(5),[9]

(3) The date for making COBRA premium payments pursuant to ERISA section 602(2)(C) and (3) and Code section 4980B(f)(2)(B)(iii) and (C),[10]

(4) The date for individuals to notify the plan of a qualifying event or determination of disability under ERISA section 606(a)(3) and Code section 4980B(f)(6)(C),

(5) The date within which individuals may file a benefit claim under the plan's claims procedure pursuant to 29 CFR 2560.503-1,

(6) The date within which claimants may file an appeal of an adverse benefit determination under the plan's claims procedure pursuant to 29 CFR 2560.503-1(h),

(7) The date within which claimants may file a request for an external review after receipt of an adverse benefit determination or final internal adverse benefit determination pursuant to 29 CFR 2590.715-2719(d)(2)(i) and 26 CFR 54.9815-2719(d)(2)(i), and

(8) The date within which a claimant may file information to perfect a request for external review upon a finding that the request was not complete pursuant to 29 CFR 2590.715-2719(d)(2)(ii) and 26 CFR 54.9815-2719(d)(2)(ii).

[CEB]

Really appreciate your comments. I was thinking it would be associated with a HIPAA event as well.