Extension of Certain Timeframes due to COVID-19

The Department of Labor and Internal Revenue Service jointly issued a rule which applies retroactively to the National Proclamation of Emergency Declaration on March 1, 2020. The “Joint Rule” extends certain timeframes for health insurers, their plan participants, qualified beneficiaries, and claimants.

The period between March 1, 2020 and 60 days after the National Emergency Declaration for COVID-19 ends, or such other date announced in a future notice, is referred to as the “Outbreak Period.” Certain timeframes are extended by disregarding (excluding) the Outbreak Period in calculating deadlines for special enrollments, COBRA elections and payments, claim submissions, and appeals.

  • The following Frequently Asked Questions are provided to help illustrate the application of these regulations. Examples within the FAQs use these date assumptions:
    • National Emergency for COVID-19 is assumed to end on October 23, 2020
    • Outbreak Period is from March 1, 2020 until 60 days after the National Emergency ends

Although the National Emergency Declaration is set to expire on October 23, 2020, the official end of the National Emergency has not been announced, so the actual end of the Outbreak Period has not yet been determined. Please consult with your legal or other advisor for more information about the Joint Rule.

HMAA will adhere to the timeframe extensions as applicable, and will continue to monitor the situation closely and implement necessary measures to ensure compliance.

Frequently Asked Questions

The following is provided for informational purposes only, and does not constitute business or legal advice.

What circumstances or events are not affected by the timeframe extension due to COVID-19?2020-06-05T23:29:43+00:00

The extension does not apply to the following; therefore, the Outbreak Period does not affect the calculation when determining timeframes in these circumstances.

  1. Initial and annual enrollment periods established by HMAA
  2. Cafeteria plan election changes other than HIPAA special enrollment periods
  3. Coverage termination for dependents who reach the age of 26
  4. Premium grace periods for coverage other than COBRA
Is there a special enrollment period for enrolling with HMAA after a loss of coverage or acquiring a new dependent?2020-06-05T23:11:12+00:00

Yes, there is a HIPAA special enrollment period (SEP) when enrolling with HMAA after a loss of coverage or acquiring a new dependent due to birth, marriage, adoption, or placement of adoption. The standard SEP of 30 days (or 60 days in the case of special enrollment rights under the Children’s Health Insurance Program Reauthorization Act of 2009) may be extended in certain circumstances as described in the following examples:

  • Example 1: On April 27, 2020, Jane adopted a child. When can she enroll the child in her HMAA plan, and when will the child be covered? Because the adoption of Jane’s child triggered a SEP (adoption as a qualifying event), the Outbreak Period is disregarded. Jane has 30 days from the end of the Outbreak Period to enroll the child with HMAA, provided she pays the premium for all periods of coverage. If the child is a newborn, coverage is effective on the date of birth; otherwise, coverage is effective on the date of adoption.
  • Example 2: On February 10, 2020, Michelle gave birth. When can she enroll the child in her HMAA plan, and when will the child be covered? Because the birth of Michelle’s child triggered a SEP (birth as a qualifying event), the Outbreak Period is disregarded. Michelle has 11 days* from the end of the Outbreak Period to enroll the child with HMAA, provided she pays the premium for all periods of coverage. Coverage is effective on the child’s date of birth. *Timeframe calculation: 30 days (SEP) – 19 days (utilized prior to Outbreak Period) = 11 days (SEP remaining).
  • Example 3: On May 20, 2020, Jon married. When can he enroll his spouse/partner in his HMAA plan, and when will his spouse/partner be covered? Because the marriage triggered a SEP (marriage as a qualifying event), the Outbreak Period is disregarded. Jon has 30 days from the end of the Outbreak Period to enroll his spouse/partner with HMAA, provided he pays the premium for all periods of coverage. The earliest coverage effective date is the first day of the month following the date of marriage.
  • Example 4: On February 25, 2020, Mike’s spouse lost her job and her employer-sponsored health coverage which also covered their two children. When can Mike enroll his spouse and children in his HMAA plan, and when will they be covered? Because the loss of coverage of Mike’s spouse triggered a SEP (loss of coverage as qualifying event), the Outbreak Period is disregarded. Mike has 26 days* from the end of the Outbreak Period to enroll his spouse and children with HMAA, provided he pays the premium for all periods of coverage. The earliest coverage effective date is the first day of the month following loss of coverage. *Timeframe calculation: 30 days (SEP) – 4 days (utilized prior to outbreak period) = 26 days (SEP remaining).
Can I extend my COBRA continuation coverage?2020-06-05T23:11:32+00:00

No, the final rule does not impact the length of time someone may retain their COBRA coverage. The Outbreak Period does not affect the timeframe for this circumstance.

  • Example 1: On May 31, 2020, Joe’s 18-month COBRA period of continued coverage with HMAA is scheduled to end and it is during the Outbreak Period. Does the final rule provide an extension in allowing Joe to continue his COBRA coverage past May? No, the final rule does not impact the length of time someone may retain their COBRA coverage; therefore his COBRA continuation coverage period cannot be extended.
Is there an extended timeframe to elect COBRA continuation coverage?2020-06-05T23:12:29+00:00

Yes, the 60-day election period (EP) for COBRA continuation coverage may be extended as described in the following examples:

  • Example 1: On March 15, 2020, Nancy loses her employment as well as her group-sponsored health coverage due to COVID-19 and is provided a COBRA election notice from HMAA on March 20, 2020. What is the deadline for Nancy to elect COBRA coverage? Because the loss of Nancy’s employment triggered a COBRA election period and the Outbreak Period is disregarded, Nancy has 60 days from the end of the Outbreak period to elect COBRA coverage. If elected and premiums are paid, her COBRA coverage will be effective March 15, 2020.
  • Example 2: On January 22, 2020, Norm’s company cuts his hours and he loses eligibility in his group-sponsored health plan. He is provided a COBRA election notice by HMAA on January 27, 2020. What is the deadline for Norm to elect COBRA coverage? Because the loss of Norm’s eligibility triggered a COBRA election period and the Outbreak Period is disregarded, Norm has 27 days* from the end of the Outbreak Period to elect COBRA coverage. If elected and premiums are paid, his COBRA coverage will be effective January 22, 2020. *Timeframe calculation: 60 days (Election Period) – 33 days (EP utilized prior to outbreak period) = 27 days (EP remaining).
  • Example 3: On April 1, 2020, Jane loses her employment as well as her group-sponsored health coverage due to COVID-19 and is provided a COBRA election notice by HMAA on April 10, 2020. Jane sends in her election form and first month of COBRA premiums on June 15, 2020 requesting that COBRA coverage become effective July 1st. Can this be accommodated? Because the loss of Jane’s employment triggered a COBRA election period, the Outbreak Period is disregarded. Jane has 60 days from the end of the Outbreak period to elect COBRA coverage. If elected and premiums are paid, her COBRA coverage will be effective April 1, 2020. No gap in coverage can exist; therefore, Jane’s request for July 1st cannot be accommodated.
Is there an extended timeframe for COBRA premium payments?2020-06-05T23:14:27+00:00

Although the deadline for making COBRA premium payments is generally 30 days from the beginning of each month (or 45 days for the initial payment), an extension may apply in certain circumstances as described in the following examples:

  • Example 1: On March 1, 2020, Lanae was receiving COBRA continuation coverage with HMAA. More than 45 days had passed since Lanae elected COBRA, and monthly premium payments are due on the first day of the month. Although Lanae made a timely payment for February, she is unable to make subsequent monthly payments due to the COVID-19 pandemic. What is the deadline for Lanae to pay outstanding monthly premiums to continue receiving COBRA continuation coverage? For purposes of determining whether COBRA premium payments are timely, the Outbreak Period is disregarded. Lanae will be covered by HMAA for all outstanding months as long as she pays all premium payments for those outstanding months within 30 days after the Outbreak Period.
  • Example 2: What if Lanae (referred to in Example 1) is unable to make the premium payments for all outstanding months within 30 days after the Outbreak Period? Lanae would only be entitled to COBRA continuation coverage for the months in which timely premium payments were made and would not be entitled to coverage for any months in which she was not able to make those payments in full. In addition, Lanae could not choose how she would like her payments applied; payments would automatically be applied to the outstanding months sequentially. For example, if Lanae is able to pay for 3 outstanding months, continuation of coverage would extend through March, April and May. She would lose coverage on June 1, 2020 and HMAA would not cover benefits or services incurred after May 31, 2020.
What is the deadline for notifying HMAA of a COBRA qualifying event or determination of disability?2020-06-05T23:14:48+00:00

The 60-day election (EP) period for individuals to notify HMAA of a COBRA qualifying event (QE) may be extended in certain circumstances as described in the following examples. COBRA qualifying events (QE) include divorce or legal separation causing the spouse to lose eligibility; a child losing eligible dependent status (e.g., upon reaching age 26); or determination of a disability that extends the maximum coverage period from 18 to 29 months.

  • Example 1: On March 30, 2020, Nick and his spouse, Melanie, divorce while covered under Nick’s HMAA plan. What is the deadline for Nick or Melanie to notify HMAA of the COBRA qualifying event and provide Melanie the opportunity to elect COBRA coverage? Because Nick and Melanie’s divorce triggered a COBRA qualifying event for Melanie, the Outbreak Period is disregarded. Nick or Melanie have 60 days from the end of the Outbreak Period to inform HMAA of the COBRA qualifying event.
  • Example 2: On February 1, 2020, Ann’s child, Billie, reached age 26 while covered under Ann’s HMAA plan and is therefore no longer an eligible dependent. What is the deadline for Ann or Billie to notify HMAA of the COBRA qualifying event, which would provide Billie the opportunity to elect COBRA coverage? Because Billie’s loss of eligible dependent status triggered a COBRA qualifying event, the Outbreak Period is disregarded. Billie has 31 days* from the end of the Outbreak Period to inform HMAA of the COBRA qualifying event. *Timeframe calculation: 60 days (Election Period) – 29 days (utilized prior to outbreak period) = 31 days (EP remaining).
  • Example 3: On February 28, 2020, Matt received a determination of disability from the U.S. Social Security Administration (SSA) qualifying Matt for a disability extension of the maximum COBRA coverage period from 18 to 29 months. Matt was previously covered under his employer-sponsored HMAA plan; however, he has been a COBRA-qualified beneficiary since December 2019 after suffering a stroke. What is the deadline for Matt to inform HMAA of his SSA determination of disability affording him the right to extension of COBRA coverage? Because Matt’s determination of disability triggered a COBRA qualifying event affording him extension of coverage, the Outbreak Period is disregarded. Matt has 58 days* from the end of the Outbreak Period to inform HMAA of the COBRA qualifying event extending his coverage. *Timeframe calculation: 60 days (Election Period) – 2 days (utilized prior to outbreak period) = 58 days (EP remaining).
What is the deadline to file a benefit claim under the HMAA’s claims procedure?2020-06-05T23:30:24+00:00

The deadline to file a benefit claim under HMAA’s claims procedures is 365 days from the date of service (DOS), which may be extended in certain circumstances as described in the following examples:

  • Example 1: On March 15, 2020, Lane received medical treatment for a condition covered under his HMAA plan. When does the related benefit claim for this treatment need to be submitted to HMAA? For purposes of determining the 365-day period applicable to Lane’s claim, the Outbreak Period is disregarded. Lane’s claim submission will be deemed timely as long as the claim is submitted within 365 days after the end of the Outbreak Period.
  • Example 2: On January 1, 2020, Lou received services from a physician. When does the related claim need to be submitted to HMAA? For purposes of determining the 365-day period applicable to Lou’s claim, the Outbreak Period is disregarded. Lou’s claim submission will be deemed timely as long as the claim is submitted within 305 days* after the end of the Outbreak Period. *Timeframe calculation: 365 days (Standard) – 60 days (utilized prior to outbreak period) = 305 days remaining.
What is the deadline to file an appeal of an adverse benefit determination?2020-06-05T23:30:49+00:00

The deadline to file an appeal of an adverse benefit determination under HMAA’s claims procedures is 365 days from the initial adverse determination (AD), which may be extended in certain circumstances as described in the following example:

  • Example 1: Angela received a denial by HMAA for a procedure she received while covered under her HMAA plan. The denial is dated February 19, 2020. If Angela decides to appeal the adverse benefit determination, when will she need to submit her appeal to HMAA? For purposes of determining the appeal deadline, the Outbreak Period is disregarded. Angela’s appeal will be deemed timely as long as she submits it within 355 days* after the end of the Outbreak Period. *Timeframe calculation: 365 days (Standard) – 10 days (utilized prior to outbreak period) = 355 days remaining.
What is the deadline to file a request for an external appeal/review after receiving an adverse benefit determination or final internal adverse benefit determination from HMAA?2020-06-05T23:15:58+00:00

The deadline to file a request for an external appeal/review after receipt of an adverse benefit determination or final internal adverse benefit determination is 130 days from HMAA’s Internal Appeals Decision, which may be extended in certain circumstances as described in the following example:

  • Example 1: On May 11, 2020, Marie received notification from HMAA that the appeal she submitted while covered under her HMAA plan was upheld/denied, her internal appeal rights were exhausted, and she was provided her rights for external appeal/review. When does Marie need to file a request for an external review of HMAA’s appeal determination? For purposes of determining the period applicable to Marie’s external review request, the Outbreak Period is disregarded. Marie’s request will be deemed timely as long as she submits her request for external review within 130 days after the end of the Outbreak Period.
What is the deadline to file additional information to the Hawaii Insurance Division to perfect a request for an external appeal/review upon finding my request was not complete?2020-06-05T23:16:31+00:00

The deadline to file additional information to perfect a request for external review by an independent review organization (IRO) to the Hawaii Insurance Division upon a finding that the request was not complete is 130 days from HMAA’s Internal Appeals Decision, which may be extended in certain circumstances as described in the following examples:

  • Example 1: On April 2, 2020, Alvin who is a dependent covered under his spouse’s HMAA plan, received notification from HMAA that the appeal he submitted was upheld/denied, his internal appeal rights were exhausted, and he was provided his rights for external appeal/review. On April 13, 2020, he submitted a request for an external IRO review to the Hawaii Insurance Division. On April 30, 2020, he received a response from the Insurance Division notifying him that his request was not complete. When must Alvin submit the additional information to perfect his request? For purposes of determining the period applicable to Alvin’s request for external review and the period applicable to perfect his request for external review, the Outbreak Period is disregarded. Alvin’s request will be deemed timely as long as he submits the additional information to perfect his request for external review within 130 days after the end of the Outbreak Period.
  • Example 2: On January 1, 2020, Chelsey received notification from HMAA that the appeal she submitted was upheld/denied, her internal appeal rights were exhausted, and she was provided her rights for external appeal/review. On February 14, 2020, she submitted a request for an external IRO review to the Hawaii Insurance Division. On March 31, 2020, she received a response from the Insurance Division notifying her that her request was not complete. When must Chelsey submit the additional information to perfect her request? For purposes of determining the period applicable to Chelsey’s external request and the period applicable to perfect her request, the Outbreak Period is disregarded. Chelsey’s request will be deemed timely as long as she submits the additional information to perfect her request for external review within 115 days* after the end of the Outbreak Period. *Timeframe calculation: 130 days (Standard) – 15 days (utilized prior to outbreak period) = 115 days remaining.

This notice was last updated on July 31, 2020.

2020-07-31T20:00:22+00:00