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    v1.0.31
    OpenPayerPolicy UpdatesAdministrative/Operational PolicyWashington HCA Emergency Reinstatement | OpenPayer
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    CurrentWashington State Health Care AuthorityPolicy 57-1

    Reinstatement for subscribers when a state of emergency is declared by the governor or a state of emergency is declared by the federal government

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    This policy governs how the SEBB Program evaluates requests to reinstate continuation coverage or school board member coverage terminated for nonpayment of premiums or applicable premium surcharges when a qualifying state or federal emergency prevented timely payment. Subscribers and permitted representatives may request reinstatement under the stated documentation and timing requirements.

    Policy Summary
    PayerWashington State Health Care Authority
    PolicyEmergency-related reinstatement of subscriber coverage
    Policy CodePolicy 57-1
    Change TypeNo material change
    Effective DateJanuary 1, 2027
    Next Review DateNot specified
    Key ActionSubmit a written reinstatement request to the SEBB Program within 120 days after the date on the HCA termination letter.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    120 daysRequest deadline
    RetroactiveApproved coverage effective date
    Unpaid premiumsPayment condition

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Appeal available
    Denial resolution

    Emergency Reinstatement Eligibility

    Emergency reinstatement eligibility

    A reinstatement request may be approved only when all applicable eligibility, documentation, timing, and payment requirements are met.

    All reinstatement requirements

    • Qualifying emergency prevented timely payment

      • A state of emergency declared by the Governor of Washington State under chapter 43.06 RCW applies

      • Federal emergency requirements

        • A federal emergency declared under 44 C.F.R. Part 206, Subpart B applies
        • The Internal Revenue Service recognizes the emergency for purposes of delaying deadlines
        • The emergency prevented the subscriber from making a timely payment

    • Required supporting information is submitted

      • The subscriber provides a statement confirming that they were impacted by the qualifying emergency
      • Supporting documents show the emergency's impact and explain why the subscriber could not make a timely payment
      • If the emergency caused the subscriber to be mentally or physically impaired or incapacitated, the subscriber meets the requirements of SEBB Program Administrative Policy 56-1
    • A written reinstatement request is received by the SEBB Program no later than 120 days after the date on the HCA termination letterNo later than 120 days
    • The subscriber or another party acting on the subscriber's behalf pays all unpaid premiums and applicable premium surcharges

    Request and Reinstatement Requirements

    Billing Rule

    Request Submission Deadline

    Submit a written request for reinstatement to the SEBB Program no later than 120 days after the date on the HCA termination letter. Include the supporting documentation required under the reinstatement eligibility determination.

    Documentation Required

    Emergency Impact Documentation

    Document how the qualifying emergency prevented the subscriber from making a timely payment. The request must include a statement from the subscriber describing the impact of the Washington State or federal emergency, along with supporting documents showing that impact and explaining why timely payment was not possible.

    • If the emergency caused the subscriber to be mentally or physically impaired or incapacitated, the subscriber must also meet the requirements in SEBB Program Administrative Policy 56-1.

    Key Terms

    Qualifying emergency
    Washington state emergencyA state of emergency declared by the Governor of Washington under chapter 43.06 RCW.
    Federal emergencyA federal emergency declared under 44 C.F.R. Part 206, Subpart B, that the Internal Revenue Service recognizes for purposes of delaying deadlines.
    Required impactThe emergency must prevent the subscriber from making a timely payment.
    Tolled election period
    Representative already on fileIf the subscriber's legal representative on file with the HCA is impacted by the emergency, the tolled election period begins when that representative is no longer impacted.
    New legal representativeIf the representative on file was also impacted, the tolled election period begins when a new legal representative is established.
    Policy Summary
    PayerWashington State Health Care Authority
    PolicyEmergency-related reinstatement of subscriber coverage
    Policy CodePolicy 57-1
    Change TypeNo material change
    Effective DateJanuary 1, 2027
    Next Review DateNot specified
    Key ActionSubmit a written reinstatement request to the SEBB Program within 120 days after the date on the HCA termination letter.
    SourceLink
    On This Page
    Emergency Reinstatement EligibilityRequest and Reinstatement RequirementsKey Terms
  1. If an HCA-filed legal representative was also impacted, the tolled election period begins when the representative is no longer impacted or when a new legal representative is established.
    2. Denial Risk

    Payment and Denial Handling

    If approved, coverage is reinstated retroactive to the termination date for nonpayment, but approval is contingent on payment of all unpaid premiums and applicable unpaid premium surcharges. If denied, coverage remains terminated; the subscriber or an authorized party may appeal to the SEBB Appeals Unit under WAC 182-32-2030.

    • Pay any unpaid premiums and applicable premium surcharges as a condition of reinstatement.
    • Follow the SEBB Appeals Unit process in WAC 182-32-2030 to appeal a denial.
    Applicable subscriberThis rule applies when a subscriber has a legal representative already on file with the HCA.