Rule2024-26014
Extension of Certain Timeframes for Employee Benefit Plans, Participants, Beneficiaries, Qualified Beneficiaries, and Claimants Affected by Hurricane Helene, Tropical Storm Helene, or Hurricane Milton
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
November 8, 2024
Issuing agencies
Treasury DepartmentInternal Revenue ServiceLabor DepartmentEmployee Benefits Security Administration
Abstract
This document announces the extension of certain timeframes under the Employee Retirement Income Security Act and the Internal Revenue Code for group health plans, disability and other welfare plans, pension plans, and participants, beneficiaries, qualified beneficiaries, and claimants of these plans affected by Hurricane Helene, Tropical Storm Helene, or Hurricane Milton.
Full Text
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<title>Federal Register, Volume 89 Issue 217 (Friday, November 8, 2024)</title>
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[Federal Register Volume 89, Number 217 (Friday, November 8, 2024)]
[Rules and Regulations]
[Pages 88642-88646]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2024-26014]
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DEPARTMENT OF THE TREASURY
Internal Revenue Service
26 CFR Part 54
DEPARTMENT OF LABOR
Employee Benefits Security Administration
29 CFR Parts 2560 and 2590
Extension of Certain Timeframes for Employee Benefit Plans,
Participants, Beneficiaries, Qualified Beneficiaries, and Claimants
Affected by Hurricane Helene, Tropical Storm Helene, or Hurricane
Milton
AGENCIES: Employee Benefits Security Administration, Department of
Labor; Internal Revenue Service, Department of the Treasury.
ACTION: Extension of timeframes.
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SUMMARY: This document announces the extension of certain timeframes
under the Employee Retirement Income Security Act and the Internal
Revenue Code for group health plans, disability and other welfare
plans, pension plans, and participants, beneficiaries, qualified
beneficiaries, and claimants of these plans affected by Hurricane
Helene, Tropical Storm Helene, or Hurricane Milton.
DATES: November 8, 2024.
FOR FURTHER INFORMATION CONTACT: Department of Labor, Elizabeth
Schumacher or David Sydlik, Office of Health Plan Standards and
Compliance Assistance, Employee Benefits Security Administration, at
202-693-8335, and Thomas Hindmarch, Office of Regulations and
Interpretations, Employee Benefits Security Administration, at 202-693-
8500; or William Fischer, Internal Revenue Service, Department of the
Treasury at 202-317-5500.
SUPPLEMENTARY INFORMATION:
I. Purpose
In this document, the Employee Benefits Security Administration,
Department of Labor, Internal Revenue Service, and Department of the
Treasury (the Agencies) are extending certain timeframes otherwise
applicable to group health plans, disability and other welfare benefit
plans, pension plans, and their participants, beneficiaries, qualified
beneficiaries, and claimants under the Employee Retirement Income
Security Act of 1974 (ERISA) and the Internal Revenue Code of 1986 (the
Code), under the authority of section 518 of ERISA and section 7508A(b)
of the Code.<SUP>1 2</SUP> In order to ensure that plans, participants,
beneficiaries, qualified beneficiaries, and claimants in disaster areas
are not further adversely affected by Hurricane Helene, Tropical Storm
Helene, and Hurricane Milton with respect to their employee benefit
plans, certain timeframes are extended during the Relief Period
established by this document, as explained in further detail below.
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\1\ ERISA section 518 and Code section 7508A(b) generally
provide that, in the case of an employee benefit plan, sponsor,
administrator, participant, beneficiary, or other person with
respect to such a plan affected by a federally declared disaster (as
defined in section 162(i)(5) of the Code), a terroristic or military
action, or a public health emergency declared by the Secretary of
Health and Human Services pursuant to section 319 of the Public
Health Service Act, notwithstanding any other provision of law, the
Secretaries of Labor and the Treasury may prescribe (by notice or
otherwise) a period of up to 1 year that may be disregarded in
determining the date by which any action is required or permitted to
be completed. Section 518 of ERISA and section 7508A(b) of the Code
further provide that no plan shall be treated as failing to be
operated in accordance with the terms of the plan solely as a result
of complying with the postponement of a deadline under those
sections.
\2\ See, e.g., Hurricane Helene Recovery: Brief Overview of FEMA
Programs and Resources, (October 3, 2024), available at <a href="https://crsreports.congress.gov/product/pdf/IN/IN12429">https://crsreports.congress.gov/product/pdf/IN/IN12429</a>; 89 FR 84908 (October
24, 2024); 89 FR 84923 (October 24, 2024); 89 FR 84919 (October 24,
2024); 89 FR 84914 (October 24, 2024); 89 FR 84912 (October 24,
2024); 89 FR 84920 (October 24, 2024).
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As a result of Hurricane Helene, Tropical Storm Helene, and
Hurricane Milton, participants, beneficiaries, qualified beneficiaries,
and claimants covered by group health plans, disability or other
employee welfare benefit plans, and employee pension benefit plans may
encounter problems in exercising their health coverage portability and
continuation coverage rights, or in filing or perfecting their benefit
claims. Recognizing the numerous challenges such individuals already
face as a result of these natural disasters, it is important that the
Agencies take steps to minimize the possibility of such individuals
losing benefits because of a failure to comply with certain pre-
established timeframes. Similarly, the Agencies recognize that affected
group health plans may have difficulty in complying with the timing of
certain notice obligations.
The Agencies believe the relief established by this document is
immediately needed to preserve and protect the benefits of
participants, beneficiaries, qualified beneficiaries, and claimants in
affected plans. Accordingly, the Agencies have determined, pursuant to
section 553 of the Administrative Procedure Act, 5 U.S.C. 553(b)(A),
(B) and 553(d), that there is good cause for granting the relief
provided by this document effective immediately upon publication, and
that notice and public participation may result in undue delay and,
therefore, be contrary to the public interest.
This document has been reviewed by the Department of Health and
Human Services (HHS), which has advised the Agencies that HHS concurs
with the relief specified in this document in the application of the
laws under its jurisdiction.\3\
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\3\ Section 104 of Title I of the Health Insurance Portability
and Accountability Act of 1996 (HIPAA) requires that the Secretaries
of Labor, the Treasury, and Health and Human Services (the
Departments) ensure through an interagency Memorandum of
Understanding (MOU) that regulations, rulings, and interpretations
issued by each of the Departments relating to the same matter over
which two or more departments have jurisdiction, are administered so
as to have the same effect at all times. Under section 104 of HIPAA,
the Departments, through the MOU, are to provide for coordination of
policies relating to enforcement of the same requirements in order
to have a coordinated enforcement strategy that avoids duplication
of enforcement efforts and assigns priorities in enforcement. See
section 104 of HIPAA and Memorandum of Understanding applicable to
Title XXVII of the PHS Act, Part 7 of ERISA, and Chapter 100 of the
Code, published at 64 FR 70164, December 15, 1999.
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HHS has advised the Agencies that HHS encourages plan sponsors of
non-Federal governmental plans and health insurance issuers offering
group or individual health insurance coverage to extend otherwise
applicable timeframes under titles XXII and XXVII of the Public Health
Service Act (PHS Act) \4\ for participants, beneficiaries, and
[[Page 88643]]
enrollees in a manner consistent with the relief provided in this
document.
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\4\ The applicable PHS Act provisions are (1) the 30-day period
(or 60-day period, if applicable) to request special enrollment
under PHS Act section 2704(f); (2) the 60-day election period for
COBRA continuation coverage under PHS Act section 2205; (3) the date
for making COBRA premium payments pursuant to PHS Act section
2202(2)(C) and (3); (4) the date for individuals to notify the plan
of a qualifying event or determination of disability under PHS Act
section 2206(3); (5) the date within which individuals may file a
benefit claim under the plan's claims procedure pursuant to 45 CFR
147.136(b) (incorporating 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 45 CFR
147.136(b) (incorporating 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 45 CFR 147.136(c)(2)(vi)
and (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 45 CFR
147.136(d)(2)(ii).
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The relief provided by this document supplements other disaster
relief guidance issued by the Agencies, which can be accessed at:
<a href="https://www.dol.gov/agencies/ebsa/employers-and-advisers/plan-administration-and-compliance/disaster-relief">https://www.dol.gov/agencies/ebsa/employers-and-advisers/plan-administration-and-compliance/disaster-relief</a> and <a href="https://www.irs.gov/newsroom/tax-relief-in-disaster-situations">https://www.irs.gov/newsroom/tax-relief-in-disaster-situations</a>.
II. Background
Title I of the Health Insurance Portability and Accountability Act
of 1996 (HIPAA) provides portability of health coverage by, among other
things, requiring special enrollment rights into group health plans
upon the loss of eligibility for other coverage or gaining a dependent
through marriage, birth, adoption or placement for adoption. ERISA
section 701, Code section 9801, 29 CFR 2590.701-6, 26 CFR 54.9801-6.
Title X of the Consolidated Omnibus Budget Reconciliation Act of 1985
(COBRA) permits certain qualified beneficiaries who lose coverage under
a group health plan to elect continuation health coverage. ERISA
section 601, Code section 4980B, 26 CFR 54.4980B-1. Section 503 of
ERISA and 29 CFR 2560.503-1 require employee benefit plans subject to
Title I of ERISA to establish and maintain reasonable procedures
governing the determination and appeal of claims for benefits under the
plan. Section 2719 of the PHS Act, incorporated into ERISA by ERISA
section 715, and into the Code by Code section 9815, imposes additional
rights and obligations with respect to internal claims and appeals and
external review for non-grandfathered group health plans and health
insurance issuers offering non-grandfathered group or individual health
insurance coverage. See also 29 CFR 2590.715-2719 and 26 CFR 54.9815-
2719. All of the foregoing provisions include timing requirements for
certain acts in connection with employee benefit plans, some of which
are being temporarily modified by this document.
A. Special Enrollment Timeframes
In general, HIPAA requires a special enrollment period in certain
circumstances, including when an employee or dependent loses
eligibility for any group health plan or other health insurance
coverage in which the employee or the employee's dependents were
previously enrolled (including coverage under Medicaid and the
Children's Health Insurance Program), and when a person becomes a
dependent of an eligible employee by birth, marriage, adoption, or
placement for adoption. ERISA section 701(f), Code section 9801(f), 29
CFR 2590.701-6, and 26 CFR 54.9801-6. Generally, group health plans
must allow such individuals to enroll in the group health plan if they
are otherwise eligible and if enrollment is requested within 30 days
after the occurrence of the event (or within 60 days, in the case of
termination of Medicaid or CHIP coverage, or eligibility for employment
assistance under Medicaid or CHIP). ERISA section 701(f), Code section
9801(f), 29 CFR 2590.701-6, and 26 CFR 54.9801-6.
B. COBRA Timeframes
The COBRA continuation coverage provisions generally provide a
qualified beneficiary a period of at least 60 days to elect COBRA
continuation coverage under a group health plan. ERISA section 605 and
Code section 4980B(f)(5). Plans are required to allow payment of
premiums in monthly installments, and plans cannot require payment of
premiums before 45 days after the day of the initial COBRA election.
ERISA section 602(3) and Code section 4980B(f)(2)(C). COBRA
continuation coverage may be terminated for failure to pay premiums
timely. ERISA section 602(2)(C) and Code section 4980B(f)(2)(B)(iii).
Under the COBRA rules, a premium is considered paid timely if it is
made not later than 30 days after the first day of the period for which
payment is being made. ERISA section 602(2)(C), Code section
4980B(f)(2)(B)(iii), and 26 CFR 54.4980B-8 Q&A-5(a). Notice
requirements prescribe time periods for employers to notify the plan of
certain qualifying events and for individuals to notify the plan of
certain qualifying events or a determination of disability. Notice
requirements also prescribe a time period for plans to notify qualified
beneficiaries of their rights to elect COBRA continuation coverage.
ERISA section 606, Code section 4980B(f)(6), and 29 CFR 2590.606-3.
C. Claims Procedure Timeframes
Section 503 of ERISA and 29 CFR 2560.503-1, as well as section 2719
of the PHS Act, incorporated into ERISA by ERISA section 715 and 29 CFR
2590.715-2719, and into the Code by Code section 9815 and 26 CFR
54.9815-2719, require ERISA-covered employee benefit plans and non-
grandfathered group health plans and health insurance issuers offering
non-grandfathered group or individual health insurance coverage to
establish and maintain a procedure governing the filing and initial
disposition of benefit claims, and to provide claimants with a
reasonable opportunity to appeal an adverse benefit determination to an
appropriate named fiduciary. Plans may not have provisions that unduly
inhibit or hamper the initiation or processing of claims for benefits.
Further, group health plans and disability plans must provide claimants
at least 180 days following receipt of an adverse benefit determination
to appeal (60 days in the case of pension plans and other welfare
benefit plans). 29 CFR 2560.503-1(h)(2)(i), 29 CFR 2560.503-1(h)(3)(i),
29 CFR 2560.503-1(h)(4), 29 CFR 2590.715-2719(b)(2)(ii)(C), and 26 CFR
54.9815-2719(b)(2)(ii)(C).
D. External Review Process Timeframes
PHS Act section 2719, incorporated into ERISA by ERISA section 715
and into the Code by Code section 9815, sets out standards for external
review that apply to non-grandfathered group health plans and health
insurance issuers offering non-grandfathered group or individual health
insurance coverage and provides for either a State external review
process or a Federal external review process. Standards for external
review processes and timeframes for submitting claims to the
independent reviewer for group health plans or health insurance issuers
may vary depending on whether a plan uses a State or Federal external
review process. For plans or issuers that use the Federal external
review process, the process must allow at least 4 months after the
receipt of a notice of an adverse benefit determination or final
internal adverse benefit determination for a request for an external
review to be filed. 29 CFR 2590.715-2719(d)(2)(i) and 26 CFR 54.9815-
2719(d)(2)(i). The Federal external review process also provides for a
preliminary review of a request for external review. The regulation
provides that if such request is not complete, the Federal external
review process must provide for a notification that describes the
information or materials needed to make the request complete, and the
plan or issuer must allow a claimant to perfect the request for
external review within the 4-month filing period or within the 48-hour
period following the receipt of the notification, whichever is later.
29 CFR 2590.715-2719(d)(2)(ii)(B) and 26 CFR 54.9815-2719(d)(2)(ii)(B).
III. Relief
A. Relief for Plan Participants, Beneficiaries, Qualified
Beneficiaries, and Claimants
With respect to plan participants, beneficiaries, qualified
beneficiaries, or claimants directly affected by Hurricane Helene,
Tropical Storm Helene, or
[[Page 88644]]
Hurricane Milton (as defined in paragraph III.C.(1)), group health
plans, disability and other employee welfare benefit plans, and
employee pension benefit plans subject to ERISA or the Code must
disregard the relevant Relief Period (as defined in paragraph II.C.(4))
for plan participants, beneficiaries, qualified beneficiaries, or
claimants located in Florida, Georgia, North Carolina, South Carolina,
Tennessee, and Virginia 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),
(2) The 60-day election period for COBRA continuation coverage
under ERISA section 605 and Code section 4980B(f)(5),\5\
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\5\ The term ``election period'' is defined as ``the period
which--(A) begins not later than the date on which coverage
terminates under the plan by reason of a qualifying event, (B) is of
at least 60 days' duration, and (C) ends not earlier than 60 days
after the later of--(i) the date described in subparagraph (A), or
(ii) in the case of any qualified beneficiary who receives notice
under section 1166(a)(4) of this title, the date of such notice.''
29 U.S.C. 1165(a)(1), ERISA section 605(a)(1). See also Code section
4980B(f)(5).
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(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),\6\
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\6\ Under this provision, the group health plan must treat the
COBRA premium payments as timely paid if paid in accordance with the
periods and dates set forth in this document. Regarding coverage
during the election period and before an election is made, see 26
CFR 54.4980B-6, Q&A 3; during the period between the election and
payment of the premium, see 26 CFR 54.4980B-8, Q&A 5(c).
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(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).
B. Relief for Group Health Plans
With respect to group health plans subject to ERISA or the Code,
and their sponsors and administrators affected by Hurricane Helene,
Tropical Storm Helene, or Hurricane Milton, the relevant Relief Period
shall be disregarded when determining the date for providing a COBRA
election notice under ERISA section 606(c) and Code section
4980B(f)(6)(D).
C. Definitions
For purposes of this document--
(1) A participant, beneficiary, qualified beneficiary, or claimant
directly affected by Hurricane Helene, Tropical Storm Helene, or
Hurricane Milton means an individual who resided, lived, or worked in
one of the disaster areas (as defined in paragraph III.C.(2)) at the
time of the hurricane or tropical storm; or whose coverage was under an
employee benefit plan that was directly affected (as defined in
paragraph III.C.(3)).
(2) The term disaster areas means the counties or tribal areas in
Florida, Georgia, North Carolina, South Carolina, Tennessee, and
Virginia that have been or are later designated as disaster areas
eligible for Individual Assistance by the Federal Emergency Management
Agency (FEMA) because of the devastation caused by Hurricane Helene,
Tropical Storm Helene, or Hurricane Milton.
(3) An employee benefit plan is directly affected by Hurricane
Helene, Tropical Storm Helene, or Hurricane Milton if the principal
place of business of the employer that maintains the plan (in the case
of a single-employer plan, determined disregarding the rules of section
414(b) and (c) of the Code); the principal place of business of
employers that employ more than 50 percent of the active participants
covered by the plan (in the case of a plan covering employees of more
than one employer, determined disregarding the rules of section 414(b)
and (c) of the Code); or the office of the plan or the plan
administrator; or the office of the primary recordkeeper serving the
plan, was located in one of the disaster areas (as defined in paragraph
III.C.(2)) at the time of the hurricane or tropical storm.
(4) The term ``Relief Period'' means--
(i) For disaster areas in Florida designated as eligible for
Individual Assistance by FEMA because of the devastation caused by
Hurricane Helene, the period beginning on September 23, 2024, and
ending on May 1, 2025;
(ii) For disaster areas in Georgia designated as eligible for
Individual Assistance by FEMA because of the devastation caused by
Hurricane Helene, the period beginning on September 24, 2024, and
ending on May 1, 2025;
(iii) For disaster areas in North Carolina, South Carolina, and
Virginia designated as eligible for Individual Assistance by FEMA
because of the devastation caused by Hurricane Helene or Tropical Storm
Helene, the period beginning on September 25, 2024, and ending on May
1, 2025;
(iv) For disaster areas in Tennessee designated as eligible for
Individual Assistance by FEMA because of the devastation caused by
Tropical Storm Helene, the period beginning on September 26, 2024, and
ending on May 1, 2025; and
(v) For disaster areas in Florida not designated as eligible for
Individual Assistance by FEMA because of the devastation caused by
Hurricane Helene (but designated as eligible for Individual Assistance
by FEMA because of the devastation caused by Hurricane Milton), the
period beginning October 5, 2024 and ending on May 1, 2025.
D. Later Extensions
The Agencies will continue to monitor the effects of Hurricane
Helene, Tropical Storm Helene, and Hurricane Milton and may provide
additional relief as warranted.
IV. Examples
The following examples illustrate the timeframe for extensions
required by this document. In each example, assume that the individual
described is directly affected by the hurricane or tropical storm.
Example 1 (Electing COBRA). (i) Facts. Individual A works for
Employer X in Buncombe County, NC and participates in X's group health
plan. Due to Tropical Storm Helene, X's business is destroyed, and the
plan terminates. Individual A has no other coverage. Employer Y is part
of the same controlled group as Employer X and continues to operate and
sponsor a group health plan. Individual A is provided a COBRA election
notice on December 1, 2024. What is the deadline for Individual A to
elect COBRA?
(ii) Conclusion. In Example 1, Individual A is eligible to elect
COBRA coverage under Employer Y's plan because Employer Y is in the
same controlled group as Employer X.\7\ The
[[Page 88645]]
Relief Period is disregarded for purposes of determining Individual A's
COBRA election period. The last day of Individual A's COBRA election
period is 60 days after May 1, 2025, which is June 30, 2025.
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\7\ Under the COBRA rules, an employee's COBRA continuation
coverage period continues even after the end of the plan, if the
employer continues to provide any group health plan to any employee.
Code section 4980B(f)(2)(B)(ii) and ERISA 602(2)(B). For purposes of
COBRA, ``employer'' includes the person for whom services are
performed and any other person that is a member of a group described
in Code section 414(b), (c), (m), or (o). 26 CFR 54.4980B-2, Q&A 2.
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Example 2 (Special enrollment period). (i) Facts. Individual B
resides in Columbia, South Carolina. Individual B is eligible for, but
previously declined participation in, her employer-sponsored group
health plan. On October 31, 2024, Individual B gives birth and would
like to enroll herself and the child into her employer's plan; however,
open enrollment does not begin until November 15, for coverage that
begins January 1. When may Individual B exercise her special enrollment
rights?
(ii) Conclusion. In Example 2, the Relief Period is disregarded for
purposes of determining Individual B's and her child's special
enrollment period. Individual B and her child qualify for special
enrollment into her employer's plan for coverage that begins on the
date of the child's birth, to the extent she satisfies all of the
plan's conditions for special enrollment that the plan may apply under
Federal law. Individual B may exercise her special enrollment rights
for herself and her child until 30 days after May 1, 2025, which is May
31, 2025, provided that she pays her share of the premiums for any
period of coverage.
Example 3 (COBRA premium payments). (i) Facts. Individual C resides
in Chatham County, Georgia. Before the hurricane, Individual C was
receiving COBRA continuation coverage under a group health plan. More
than 45 days had passed since Individual C had elected COBRA. Monthly
premium payments are due by the first of the month. The plan does not
permit qualified beneficiaries longer than the statutory 30-day grace
period for making premium payments. Individual C made a timely
September payment, but did not make the October payment or any
subsequent payments during the Relief Period. As of May 1, 2025,
Individual C has made no premium payments for October, November,
December, January, February, March, April, or May. Does Individual C
lose COBRA coverage, and if so for which month(s)?
(ii) Conclusion. In this Example 3, the Relief Period is
disregarded for purposes of determining whether monthly COBRA premium
installment payments are timely. Premium payments made by 30 days after
May 1, 2025, which is May 31, 2025, for October, November, December,
January, February, March, April, and May, are timely, and Individual C
is entitled to COBRA continuation coverage for these months if she
timely makes payment. Under the terms of the COBRA statute, premium
payments are timely if made within 30 days from the date they are first
due. In calculating the 30-day period, however, the Relief Period is
disregarded, and payments for October, November, December, January,
February, March, and April are all deemed to be timely if they are made
within 30 days after the end of the Relief Period. Premium payments for
May are deemed timely if they are made within 30 days after they are
first due (May 1). Accordingly, premium payments for October, November,
December, January, February, March, and April, as well as premium
payments for May, are all due by May 31, 2025. Since the due dates for
Individual C's premiums would be postponed and Individual C's payment
for premiums would be retroactive during the initial COBRA election
period, Individual C's insurer or plan may initially deny claims and
then, after premiums are paid, must make retroactive payment for
benefits and services received by the participant during this time.
Example 4 (COBRA premium payments). (i) Facts. Same facts as
Example 3. By May 31, 2025, Individual C made a payment equal to two
months' premiums. For how long does Individual C have COBRA
continuation coverage?
(ii) Conclusion. Individual C is entitled to COBRA continuation
coverage for October and November of 2024, the two months for which
timely premium payments were made, and Individual C is not entitled to
COBRA continuation coverage for any month after November 2024. Items
and services covered by the group health plan (e.g., doctors' visits or
filled prescriptions) that were furnished on or before November 30,
2024 would be covered under the terms of the plan. The plan would not
be obligated to cover items or services furnished after November 30,
2024.
Example 5 (Claims for medical treatment under a group health plan).
(i) Facts. Individual D lives in Caldwell County, North Carolina and is
a participant in a group health plan. On October 15, 2023, Individual D
received medical treatment for a condition covered under the plan, but
a claim relating to the medical treatment was not submitted until
October 20, 2024. Under the plan, claims must be submitted within 365
days of the participant's receipt of the medical treatment. Was
Individual D's claim timely?
(ii) Conclusion. Yes. Absent this relief, the last day for
Individual D to submit a claim was October 14, 2024. For purposes of
determining the 365-day period applicable to Individual D's claim, the
Relief Period is disregarded. As of the first day of the Relief Period,
Individual D had 19 days to file the claim (September 25, 2024, through
October 14, 2024). Therefore, Individual D's last day to submit a claim
is 19 days after May 1, 2025, which is May 20, 2025, so Individual D's
claim was timely. If the plan has already denied Individual D's claim
as untimely, the claim may have to be resubmitted and, if the claim is
fully or partially denied, the plan may need to send an updated adverse
benefit determination.
Example 6 (Internal appeal--disability plan). (i) Facts. Individual
E resides in Gulf County, Florida and received a notification of an
adverse benefit determination from Individual E's disability plan on
August 28, 2024. The notification advised Individual E that there are
180 days within which to file an appeal. What is Individual E's appeal
deadline?
(ii) Conclusion. When determining the 180-day period within which
Individual E's appeal must be filed, the Relief Period is disregarded.
Therefore, Individual E's last day to submit an appeal is 154 days
(180--26 days following August 28 to September 23) after May 1, 2025,
which is October 2, 2025.
Example 7 (Internal appeal--employee pension benefit plan). (i)
Facts. Individual F resides in Greene County, Tennessee and received a
notice of adverse benefit determination from Individual F's 401(k) plan
on November 15, 2024. The notification advised Individual F that there
are 60 days within which to file an appeal. What is Individual F's
appeal deadline?
(ii) Conclusion. When determining the 60-day period within which
Individual F's appeal must be filed, the Relief Period is disregarded.
Therefore, Individual F's last day to submit an appeal is 60 days after
May 1, 2025, which is June 30, 2025.
[[Page 88646]]
Signed at Washington, DC, this 4th day of November, 2024.
Lisa M. Gomez,
Assistant Secretary, Employee Benefits Security Administration,
Department of Labor.
Douglas W. O'Donnell,
Deputy Commissioner, Internal Revenue Service, Department of the
Treasury.
[FR Doc. 2024-26014 Filed 11-7-24; 8:45 am]
BILLING CODE P
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</html>Indexed from Federal Register on November 8, 2024.
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