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 from the one-year extension date that the timeline would have started (March 15, 2021), in this case by the deadline (March 15, 2022).
  • 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 (February 28, 2021), in this case by the deadline (December 30, 2021). *Timeframe calculation: 365 days (Standard) – 60 days (utilized prior to outbreak period) = 305 days remaining.