Wisconsin OCI Issues Bulletin on Group Health Plan Extension

Compliance, COVID-19, Employee Benefits

On June 10, 2020, The Office of the Commissioner of Insurance in Wisconsin (OCI) issued a bulletin regarding the recent federal regulations extending certain deadlines for group health plans during the COVID-19 pandemic. The bulletin encourages state governmental group health plans and also insurers to apply the extensions to similar Wisconsin provisions.

The federal regulations, which were released on May 4, 2020, defined an outbreak period that is to be disregarded when applying certain group health plan deadlines. The outbreak period is March 1, 2020 until 60 days after the end of the national emergency.

This relief applies to the following deadlines:

  • COBRA: 60 day election period, premium due dates, and notification of qualifying event or determination of disability
  • HIPAA Special Enrollment: 30 day enrollment period (or 60 day period under CHIPRA)
  • Benefit claims procedure
  • Appeal for an adverse benefit determination
  • Request of external review or final internal adverse benefit determinations

Although the federal requirements are not mandatory for public sector plans in the state of Wisconsin, OCI confirms that the federal Department of Health and Human Services (HHS) encourages those plans to provide the relief as granted by the requirements.

The OCI bulletin requests that insurers extend the same relief to non-ERISA group plans under the following state requirements:

  • State continuation premium payments and effective date applicability
  • State independent review timeframes , including response times for requested documents

Key Takeaway

This bulletin from OCI further clarifies for insurers their role in implementing group health plan rule changes that are required for private sector employer health plan sponsors. If you have questions or concerns about how this notice pertains to your group health plan, please contact your M3 Account Team to discuss.

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