The extension never applied to the following; therefore, the Outbreak Period did not affect timeframes in these circumstances.

1. Initial and annual enrollment periods established by Plan Sponsor
2. Cafeteria plan election changes other than HIPAA special enrollment periods
3. Coverage termination for dependents who reach the age of 26
4. Premium grace periods for coverage other than COBRA

Yes, there is a HIPAA special enrollment period (SEP) when enrolling with HWMG after a loss of coverage or acquiring a new dependent due to birth, marriage, adoption, or placement of adoption. The standard SEP of 31 days (or 60 days in the case of special enrollment rights under the Children’s Health Insurance Program Reauthorization Act of 2009) may be extended in certain circumstances as described in the following examples:

• Example 1: On April 1, 2022, Jane adopted a child. When can she enroll the child in her employer-sponsored plan, and when will the child be covered? The adoption of Jane’s child triggered a SEP (adoption as a qualifying event), and for purposes of determining the 31-day period applicable to the SE the Outbreak period is disregarded as the event exhausted the one-year extension date that the timeline would have started on April 2, 2023. Therefore in this case Jane has until the deadline May 2, 2023 (31 days from April 1, 2023) to enroll the child with HWMG, provided she pays the premium for all periods of coverage. If the child is a newborn, coverage is effective on the date of birth; otherwise, coverage is effective on the date of adoption..
• Example 2: On February 10, 2023, Michelle gave birth. When can she enroll the child in her employer-sponsored plan, and when will the child be covered? The birth of Michelle’s child triggered a SEP (birth as a qualifying event), and for purposes of determining the 31-day period applicable to the SE the Outbreak Period is regarded as the event has not exhausted the one-year maximum and has hit the Outbreak Period Deadline of June 10, 2023. Therefore in this case Michelle has until the deadline July 11, 2023 (31 days from June 10, 2023) to enroll the child with HWMG, provided she pays the premium for all periods of coverage. Coverage is effective on the child’s date of birth.
• Example 3: On May 20, 2022, Jon married. When can he enroll his spouse/partner in his employer-sponsored plan, and when will his spouse/partner be covered? Jon’s marriage triggered a SEP (marriage as a qualifying event), and for purposes of determining the 31-day period applicable to the SE the Outbreak period is disregarded as the event exhausted the one-year extension date that the timeline would have started on May 21, 2023. Therefore in this case Jon has 31 days until the deadline June 21, 2023 (31 days from May 20, 2023) to enroll his spouse/partner with HWMG, provided he pays the premium for all periods of coverage.
• Example 4: On February 25, 2023, Mike’s spouse lost her job and her employer-sponsored health coverage which also covered their two children. When can Mike enroll his spouse and children in his HWMG plan, and when will they be covered? The loss of coverage of Mike’s spouse triggered a SEP (loss of coverage as qualifying event), and for purposes of determining the 31-day period applicable to the SE the Outbreak Period is regarded as the event has not exhausted the one-year maximum and has hit the Outbreak Period Deadline of June 10, 2023. Therefore in this case Mike has until the deadline July 11, 2023 (31 days from June 10, 2023) to enroll his spouse and children with HWMG, provided he pays the premium for all periods of coverage. The earliest coverage effective date is the first day of the month following loss of coverage.

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, 2023, Joe’s 18-month COBRA period of continued coverage with his employer-sponsored plan is scheduled to end and it is during the Outbreak Period. Does the final rule provide an extension in allowing Joe to continue his COBRA coverage past May? No, the final rule does not impact the length of time someone may retain their COBRA coverage; therefore his COBRA continuation coverage period cannot be extended.

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, 2022, Nancy loses her employment as well as her employer-sponsored health coverage due to COVID-19 and is provided a COBRA election notice by HWMG on March 20, 2022. What is the deadline for Nancy to elect COBRA coverage? The loss of Nancy’s employment triggered a COBRA election period and for purposes of determining the 60-day election period the Outbreak Period is disregarded as the event exhausted the one-year extension date that the timeline would have started on March 16, 2023. Therefore in this case Nancy has until the deadline May 14, 2023 (60 days from March 15, 2023) to elect COBRA coverage. If elected and premiums are paid, her COBRA coverage will be effective March 15, 2022
• Example 2: On May 25, 2023, Norm’s company cuts his hours and he loses eligibility in his employer-sponsored health plan. He is provided a COBRA election notice by HWMG on May 30, 2023. What is the deadline for Norm to elect COBRA coverage? The loss of Norm’s eligibility triggered a COBRA election period and for purposes of determining the 60-day election period, the Outbreak Period is regarded as the event has not exhausted the one-year maximum and has hit the Outbreak Period Deadline of June 10, 2023. Therefore in this case Norm has until the deadline August 9, 2023 (60 days from June 10, 2023) to elect COBRA coverage. If elected and premiums are paid, his COBRA coverage will be effective June 25, 2023.
• Example 3: On April 1, 2022, Jane loses her employment as well as her employer-sponsored health coverage due to COVID-19 and is provided a COBRA election notice by HWMG on April 10, 2022. Jane sends in her election form and first month of COBRA premiums on June 15, 2021 requesting that COBRA coverage become effective July 1, 2022. Can this be accommodated The loss of Jane’s employment triggered a COBRA election period and for purposes of determining the 60-day election period, the Outbreak Period is disregarded as the event exhausted the one-year extension date the timeline would have started on April 11, 2023. Therefore in this case Jane has until the deadline June 9, 2023 (60 days from April 10, 2023) to elect COBRA coverage. If elected and premiums are paid, her COBRA coverage will be effective April 1, 2022. No gap in coverage can exist; therefore, Jane’s request for July 1, 2022 cannot be accommodated.

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, 2023, Lanae was receiving COBRA continuation coverage with her employer-sponsored plan. More than 45 days had passed since Lanae elected COBRA, and monthly premium payments are due on the first day of the month. Although Lanae made a timely payment for February, she is unable to make subsequent monthly payments due to the COVID-19 pandemic. What is the deadline for Lanae to pay outstanding monthly premiums to continue receiving COBRA continuation coverage? For purposes of determining whether COBRA premium payments are timely, the Outbreak Period is regarded as the event has not exhausted the one-year maximum and has hit the Outbreak Period Deadline of June 10, 2023. Lanae will be covered by HWMG for all outstanding months as long as she pays all premium payments for those outstanding months by deadline July 10, 2023 (30 days from June 10, 2023).
• Example 2: What if Lanae (referred to in Example 1) is unable to make the premium payments for all outstanding months within 30 days after the end of Outbreak Period deadline June 10, 2023? Lanae would only be entitled to COBRA continuation coverage for the months in which timely premium payments were made and would not be entitled to coverage for any months in which she was not able to make those payments in full. In addition, Lanae could not choose how she would like her payments applied; payments would automatically be applied to the outstanding months sequentially. For example, if Lanae is able to pay for 3 outstanding months, continuation of coverage would extend through March, April and May. She would lose coverage on June 1, 2023 and HWMG would not cover benefits or services incurred after May 31, 2023.

The 60-day election (EP) period for individuals to notify HWMG 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 determination of a disability that extends the maximum coverage period from 18 to 29 months.

• Example 1: On March 30, 2022, Nick and his spouse, Melanie, divorce while covered under Nick’s employer-sponsored plan. What is the deadline for Nick or Melanie to notify HWMG of the COBRA qualifying event and provide Melanie the opportunity to elect COBRA coverage? Nick and Melanie’s divorce triggered a COBRA qualifying event for Melanie, and for purposes of determining the 60-day election period the Outbreak Period is disregarded as the event exhausted the one-year extension date that the timeline would have started on March 31, 2023. Therefore, in this case Nick or Melanie have until the deadline May 29, 2023 (60 days from March 30, 2023) to inform HWMG of the COBRA qualifying event.
• Example 2: On February 1, 2023, Ann’s child, Billie, reached age 26 while covered under Ann’s employer-sponsored plan and is therefore no longer an eligible dependent. What is the deadline for Ann or Billie to notify HWMG of the COBRA qualifying event, which would provide Billie the opportunity to elect COBRA coverage? Billie’s loss of eligible dependent status triggered a COBRA qualifying event and for purposes of determining the 60-day election period the Outbreak Period is regarded as the event has not exhausted the one-year maximum and has hit the Outbreak Period Deadline of June 10, 2023. Therefore, in this case Billie has until the deadline August 9, 2023 (60 days from June 10, 2023) to inform HWMG of the COBRA qualifying event.
• Example 3: On February 28, 2022, Matt received a determination of disability from the U.S. Social Security Administration (SSA) qualifying Matt for a disability extension of the maximum COBRA coverage period from 18 to 29 months. Matt was previously covered under his employer-sponsored plan; however, he has been a COBRA-qualified beneficiary since December 2021 after suffering a stroke. What is the deadline for Matt to inform HWMG of his SSA determination of disability affording him the right to extension of COBRA coverage? Matt’s determination of disability triggered a COBRA qualifying event affording him extension of coverage, and for purposes of determining the 60-day election period the Outbreak Period is disregarded as the event exhausted the one-year extension date that the timeline would have started on March 1, 2023. Therefore in this case Matt has until the deadline April 29, 2023 (60 days from February 28, 2023) to inform HWMG of the COBRA qualifying event extending his coverage.

The deadline to file a benefit claim under HWMG’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, 2023, Lane received medical treatment for a condition covered under his employer-sponsored plan. When does the related benefit claim for this treatment need to be submitted to HWMG? For purposes of determining the 365-day period applicable to Lane’s claim, the Outbreak Period is regarded as the event has not exhausted the one-year maximum and has hit the Outbreak Period Deadline of June 10, 2023. Therefore, in this case, Lane’s claim submission will be deemed timely as long as the claim is submitted by the deadline June 10, 2024 (365 days from June 10, 2023).
• Example 2: On January 1, 2022, Lou received services from a physician. When does the related claim need to be submitted to HWMG? For purposes of determining the 365-day period applicable to Lou’s claim, the Outbreak Period is disregarded as the event exhausted the one-year extension date that the timeline would have started on January 2, 2023. Therefore, in this case, Lou’s claim submission will be deemed timely as long as the claim is submitted by the deadline January 2, 2024 (365 days from January 1, 2023).

The deadline to file an appeal of an adverse benefit determination under HWMG’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 HWMG for a procedure she received while covered under her employer-sponsored plan. The denial is dated February 19, 2022. If Angela decides to appeal the adverse benefit determination, when will she need to submit her appeal to HWMG? For purposes of determining the appeal deadline, the Outbreak Period is disregarded as the event exhausted the one-year extension date that the timeline would have started on February 20, 2023. Therefore, in this case, Angela’s appeal will be deemed timely as long as she submits it by the deadline February 20, 2024 (365 days from February 19, 2023).
• Example 2: Bill received a denial by HWMG for a procedure she received while covered under her employer-sponsored plan. The denial is dated May 1, 2023. If Bill decides to appeal the adverse benefit determination, when will he need to submit his appeal to HWMG? For purposes of determining the appeal deadline, the Outbreak Period is regarded as the event has not exhausted the one-year maximum and has hit the Outbreak Period Deadline of June 10, 2023. Therefore, in this case Bill’s appeal will be deemed timely as long as he submits it by the deadline June 10, 2024 (365 days from June 10, 2023).

For information on what qualifies for an IRO review and how to submit a request, please contact our Customer Service Center. 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 HWMG’s Internal Appeals Decision, which may be extended in certain circumstances as described in the following example:

• Example 1: On April 11, 2022, Marie received notification from HWMG that the appeal she submitted while covered under her employer-sponsored plan was upheld/denied, her internal appeal rights were exhausted, and she was provided her rights for external appeal/review. When does Marie need to file a request for an external review of HWMG’s appeal determination? For purposes of determining the period applicable to Marie’s external review request, the Outbreak Period is disregarded as the event exhausted the one-year extension date that the timeline would have started on April 12, 2023. Therefore, in this case, Marie’s request will be deemed timely as long as she submits her request for external review by the deadline August 19, 2023 (130 days from April 11, 2023).

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 HWMG’s Internal Appeals Decision, which may be extended in certain circumstances as described in the following examples:

• Example 1: On April 2, 2022, Alvin who is a dependent covered under his spouse’s employer-sponsored plan, received notification from HWMG 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, 2022, he submitted a request for an external IRO review to the Hawaii Insurance Division. On April 30, 2022, 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 as the event exhausted the one-year extension date that the timeline would have started on April 3, 2023. Therefore, in this case, Alvin’s request will be deemed timely as long as he submits the additional information to perfect his request for external review by the deadline August 10, 2023 (130 days from April 2, 2023.
• Example 2: On May 1, 2023, Chelsey received notification from HWMG 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 June 1, 2023, she submitted a request for an external IRO review to the Hawaii Insurance Division. On July 7, 2023, 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 regarded as the event has not exhausted the one-year maximum and has hit the Outbreak Period Deadline of June 10, 2023.  Therefore, in this case, Chelsey’s request will be deemed timely as long as she submits the additional information to perfect her request for external review by the deadline October 18, 2023 (130 days from June 10, 2023).