Due to the COVID19 pandemic, the Department of Labor (DOL) and the Internal Revenue Service (IRS) passed the COVID19 Relief Rule extending certain timeframes during the COVID19 National Emergency.
The COVID-19 Relief Rule aims to provide health coverage relief from March 1, 2020 until sixty (60) days after the announced end of the National Emergency. Upon the announced end of the National Emergency, the timelines will revert to the applicable timelines associated with each qualifying event.
The relief applies to several timeframe limitations within the CalPERS Health Benefits Program including:
- Health Insurance Portability and Accountability Act of 1996 (HIPAA) Special Enrollment Periods (SEP)
- Election of Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage and timely payments
Special Enrollment Periods
SEPs refers to several types of enrollments, after an initial enrollment opportunity period, which provides a 60-day period for members to provide evidence (notify) to CalPERS of the specific qualifying event that makes them eligible for an SEP. The Rule is focused on the following SEP qualifying events:
- New enrollment due to loss of other coverage; and
- Adding a dependent(s) due to marriage, birth, adoption, or placement for adoption
Additionally, a special enrollment right also arises for employees and their dependents who lose coverage under a state Children's Health Insurance Program (CHIP) or Medicaid or who are eligible to receive premium assistance under those programs.
Federal law provides individuals with a 60-day window to elect continued health coverage through COBRA. The Rule provides extended relief past the normal time frames, allowing individual COBRA enrollment rights throughout the national emergency. The COBRA enrollment, however, must be continuous from the date coverage ended.
Collection of COBRA premiums is administered by the specific health plan providing coverage. Normal COBRA rules define timely payment of COBRA premiums as premiums that are made within 30 days after the due date or within such longer period as applies to or under the plan. The Rule stipulates application of the relief period to the timely collection of COBRA premiums, which will prevent individual health cancellations due to late or non-payment until 90 days after the national emergency is declared over.
Other Enrollment Types
This Rule does not impact other types of enrollments, including, but not limited to, Parent Child Relationships, Dependent Eligibility Verifications, Disabled Dependent Enrollments, and health plan change requests. These enrollment types are not covered under HIPAA therefore they are not subject to the COVID19 Relief Rule.
Under the COVID19 Relief Rule, the 60-day limitations that currently apply to the Special Enrollment Periods and COBRA elections are being waived during the National Emergency period for those qualifying events that occurred after March 1, 2020. Contact the CalPERS Contact Center by calling 888 CalPERS (or 888-225-7377) for assistance with your enrollment request.
- Special Enrollment Periods - members have the option to enroll and/or add a dependent(s) on a current or retroactive basis.
- COBRA enrollments require continuous coverage. Effective date would be retroactive to the cancelation date.
If CalPERS determines that due to extenuating circumstances the member is unable to produce a marriage certificate or domestic partnership registration, the member may execute and submit a signed and notarized CalPERS Affidavit of Marriage/Domestic Partnership (PDF). Additionally, if a member is unable to obtain a government issued birth certificate for a dependent child due to COVID19, the member may provide a hospital birth record to facilitate the enrollment and provide the government issued birth certificate once it is available.
Benefit Claim(s) and Appeal(s) Extensions
The COVID19 Relief Rule extended the filing timeframes by until sixty (60) days after the announced end of the National Emergency:
- Claims for benefit payment (generally limited to 15-months from the date of service prior to the COVID19 Relief Rule)
- Health Plan Appeal (generally limited to 180-days from the date of the adverse benefit decision)
- External Independent Medical Review (generally limited to 4-months from the date the health plan issued their appeal denial prior to the COVID19 Relief Rule)
In response to the COVID19 pandemic, Governor Gavin Newsom issued Executive Order (EO) N-40-20 effective March 30, 2020, extending CalPERS Administrative Review (AR) and Administrative Hearing (AH) requests by an additional 60 days.
- Administrative Review – Members have 90 days from the date of the health plan or external review adverse appeal decision to file a request (limited to 30-days prior to the EO).
- Administrative Hearing – Members have 90 days from the date of the CalPERS AR decision to file a request (limited to 30-days prior to the EO).