Does HMAA have a MedicalRx list?
Yes, please refer to our Commercial Medical Rx List which includes drugs that may require prior authorization.
Will HMAA grant leniency if I do not pay my premiums on time during the COVID-19 situation?
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.
Is my group’s COBRA Continuation Coverage status still active?
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 [...]
If I close my business today due to COVID-19 and rehire employees a few weeks or months later, can HMAA waive the 4-week waiting period to re-enroll those employees?
If you rehire employees who were previously covered under your plan, HMAA can waive the 4-week waiting period for these employees if they are re-enrolled within 6 months of losing coverage. Thereafter, employees will be subject to the standard 4-week waiting period and must meet the eligibility requirements for hours worked in order to enroll. [...]
Can I unbundle my group’s drug, vision, and dental offerings so they are no longer employer-sponsored and instead offer these as voluntary coverage whereby my employees would be responsible for paying the premiums?
No, you may not unbundle your rider offerings and offer these as voluntary coverage to your employees. However, HMAA provides the following options to help mitigate the loss of employer-provided coverage: Optum Perks is a prescription drug savings program through which your employees can obtain a free discount card online and instantly save on select [...]
Can I temporarily change my group’s plan offerings to help reduce costs?
HMAA previously accommodated employer requests to change plan offerings outside of open enrollment; however, plan changes are now allowed only during your company’s open enrollment/renewal period with HMAA.
Can I continue to pay for my employees’ health coverage if they are placed on furlough or no longer meet the eligibility requirements for hours worked due to COVID-19?
HMAA accommodated employer requests to maintain health coverage until January 31, 2021 for employees who did not meet the 20-hour eligibility requirement per the Prepaid Healthcare Act. Effective February 1, 2021, employees must meet the health plan eligibility requirements, which include working at least 20 hours per week, in order to remain covered.
Does HMAA provide Electronic Remittance Advice (ERA) and Electronic Payment Services?
Yes, we offer ERA and ePayment services through Zelis Payments. Contact our Provider Relations Department for further information.
Should I submit the same claims electronically AND by paper just to be sure they are received?
Please choose either paper or electronic filing, not both. Filing twice, by paper and electronically, will result in duplicate claim handling by HMAA. Note: This does not apply to specific requests by HMAA for paper claims with additional attachments that must be submitted by paper.
Why is HMAA receiving paper claims from us when we transmit electronically?
Some vendors offer a service that automatically converts electronic claims to paper if they are rejected during transmission to the next vendor. Review your SDS rejection reports and contact your vendor to discuss how they handle rejected claims.