Identify who has had an involuntary termination of employment or reduction in hours and is still within the 18-month COBRA period. Provide these individuals with the notice and special election form to elect COBRA. HMAA will do this if we administer COBRA on your behalf. Modify your payroll administration to incorporate the COBRA subsidy. This [...]
For the duration of the Subsidy Period, plan sponsors will pay COBRA premiums for their AEIs. The full amount of the premium will be reimbursed by the federal government via an employer tax credit. The sponsor of a plan may claim a credit against its liability for Medicare payroll taxes.
ARPA imposed three notice requirements on employers, which HMAA can send on your behalf if your company does not self-administer COBRA: Special Election Opportunity: No later than May 31, 2021, employers must provide notice to AEIs who are eligible for the special election opportunity. New Qualifying Beneficiaries: Employers must notify AEIs who become eligible to [...]
ARPA created a Special COBRA Election Period for AEIs to enroll and receive subsidized coverage for up to 6 months. Employers must offer this special election opportunity to AEIs who are eligible for subsidies. The Special COBRA Election Period lasts for 60 days, which begins when the AEI receives notice of the opportunity.
There are 3 ways an AEI may qualify for the subsidy: The AEI elects COBRA coverage when he/she first becomes eligible for COBRA coverage during the 6-month subsidy period. The AEI elected COBRA for coverage prior to April 1, 2021, has been paying premiums, remains enrolled in COBRA coverage at any time during the subsidy [...]
An employee and his/her covered dependents: Who would be entitled to COBRA coverage under a health plan any time between April 1, 2021 and September 30, 2021 due to the employee’s involuntary termination of employment or reduction in hours (not gross misconduct); or Whose current COBRA continuation coverage period includes some or all of the [...]
The Subsidy Period begins on the later of April 1, 2021 or the date the AEI becomes eligible for COBRA coverage. The Subsidy Period ends on the earliest of (a) September 30, 2021; (b) the end of the 18-month maximum COBRA coverage period; or (c) the date the individual becomes eligible for other group health coverage or Medicare. [...]
Yes, please refer to our Commercial Medical Rx List which includes drugs that may require prior authorization.
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?
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 [...]
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?
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 [...]