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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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
The extension does not apply to the following; therefore, the Outbreak Period does not affect the calculation when determining timeframes in these circumstances. Initial and annual enrollment periods established by HMAA Cafeteria plan election changes other than HIPAA special enrollment periods Coverage termination for dependents who reach the age of 26 Premium grace periods for [...]
Previously HMAA extended its grace period for payments to forty-five (45) days; however, effective September 1, 2021 the grace period for payments has reverted to 30 days. For example, September 2021 premium was due on September 1, 2021, and including the grace period you have until September 30, 2021 to make payment.
Your group’s COBRA Continuation Coverage status is still active if you employed at least 20 full-time equivalent employees (FTEs) for at least 6 months during the preceding calendar year and informed HMAA of this by providing your company’s UC-B6 or Quarterly Wage Report for the preceding year. Your COBRA coverage will remain in active status [...]
