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 from the one-year extension date that the timeline would have started (April 2, 2021), in this case by the deadline (August 10, 2021).
  • 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 (February 28, 2021), in this case by the deadline (June 23, 2021). *Timeframe calculation: 130 days (Standard) – 15 days (utilized prior to outbreak period) = 115 days remaining.