Has the DOL and IRS waived the requirement that summaries of material modification be issued within 60 days?

Posted by: Bonita Hatchett-Bodle    May 1, 2020 2:09:04 PM

Yes. Under the Public Health Services Act (PHSA), if a plan makes a material modification, as defined under ERISA, in any of the terms of the plan or coverage that would affect the content of the Summary of Benefits and Coverage (SBC) that is not reflected in the most recently provided SBC, and that occurs other than in connection with a renewal or reissuance of coverage, the plan or issuer must provide notice of the modification to enrollees not later than 60 days prior to the date on which the modification will become effective.

However, the Department of Labor (DOL), Department of Health and Human Services (HHS), and the Treasury Department will not take enforcement action against any plan or issuer that makes a modification to provide greater coverage related to the diagnosis or treatment of COVID-19 without providing at least 60 days advance notice. Modifications to add benefits or reduce cost-sharing for telehealth and other remote care services are included. Plans and issuers must provide notice of the changes as soon as reasonably practicable. Health insurance issuers that change benefits or the cost-sharing structure of its plans mid-year to provide increased coverage for services related to the diagnosis or treatment of COVID-19 will not violate the guaranteed renewability of requirements under the PHSA. These nonenforcement policies remain in effect during the public health emergency related to COVID-19.

Topics: Summary of Material Modifications, FFCRA, CARES Act