In April, President Biden signed Joint House Resolution H.R. 7 into law which put an end to the national health emergency on May 11, 2023. Under the national emergency, federal agencies provided temporary relief from certain rules that would otherwise apply to various programs including Flexible Spending Accounts (FSA) and Health Reimbursement Arrangements (HRA).
As of July 10, 2023 (the declaration called for a 60-day wind down period after the end of the emergency), we return to normal claims filing and appeal deadlines. This is big news! During the national emergency, deadlines for filing FSA and HRA claims and appealing denied claims seemed to go on forever with no end in sight. This eternal file/appeal period wreaked all kinds of havoc. For instance, during the emergency, assuming a participant had money in their account and their eligible expense was incurred during a plan year, they could submit late claims even to terminating plans.
As a result, we kept old plans operating on the off chance that someone with an unused balance might submit an eligible claim. Finally, we can close those plans down and return to the normal claim filing deadlines which are:
-
- 60 days after the end of a plan year, or
- 60 days after the end of a grace period, or
- 60 days after termination of employment or termination from the plan
Appeal deadlines also return to normal. If we deny an FSA or HRA claim, the participant will receive written notice of the denial (or request for more information) within 30 days of the receipt of the claim. There may be a need for an extended time to review the claim, up to 15 days. The denial must include enough information for the participant to understand why the claim was denied. If the participant disagrees with the denial, an appeal must be made within 180 days after receipt of the denial notice.
As a refresher, here is our normal filing and appeal procedure as outlined in our Summary Plan Description:
Step 1: Notice is received from Plan Service Provider. If your claim is denied, you will receive written notice from the Plan Service Provider that your claim is denied as soon as reasonably possible but no later than 30 days after receipt of the claim. For reasons beyond the control of the Plan Service Provider, the Plan Service Provider may take up to an additional 15 days to review your claim. You will be provided written notice of the need for additional time prior to the end of the 30-day period. If the reason for the additional time is that you need to provide additional information, you will have 45 days from the notice of the extension to obtain that information. The time period during which the Plan Service Provider must make a decision will be suspended until the earlier of the date that you provide the information or the end of the 45-day period.
Step 2: Review your notice carefully. Once you have received your notice from the Plan Service Provider, review it carefully. The notice will contain:
- the reason(s) for the denial and the Plan provisions on which the denial is based;
- a description of any additional information necessary for you to perfect your claim, why the information is necessary, and your time limit for submitting the information;
- a description of the Plan’s appeal procedures and the time limits applicable to such procedures; and
- a right to request all documentation relevant to your claim.
Step 3: If you disagree with the decision, file an Appeal. If you do not agree with the decision of the Plan Service Provider and you wish to appeal, you must file your appeal no later than 180 days after receipt of the notice described in Step 1. You should submit all information identified in the notice of denial as necessary to perfect your claim and any additional information that you believe would support your claim.
Step 4: Notice of Denial is received from Plan Service Provider. If the claim is again denied, you will be notified in writing as soon as possible but no later than 30 days after receipt of the appeal by the Plan Service Provider.
Step 5: Review your notice carefully. You should take the same action that you took in Step 2 described above. The notice will contain the same type of information that is provided in the first notice of denial provided by the Plan Service Provider.
Step 6: If you still disagree with the Plan Service Provider’s decision, file a 2nd Level Appeal with the Plan Administrator. If you still do not agree with the Plan Service Provider’s decision and you wish to appeal, you must file a written appeal with the Plan Administrator within the period set forth in the first level appeal denial notice from the Plan Service Provider. You should gather any additional information that is identified in the notice as necessary to perfect your claim and any other information that you believe would support your claim.
If the Plan Administrator denies your 2nd Level Appeal, you will receive notice within 30 days after the Plan Administrator receives your claim. The notice will contain the same type of information that was referenced in Step 2 above.
We’re looking forward to getting back to a normal course of business without having to check ourselves on the standard rules vs. the COVID rules. Change is good, sometimes. But with all the changes that bombarded us during the national emergency, this ole girl is content to keep things consistent and unchanged for a good long while.