CurrentWashington State Health Care AuthorityPolicy 57-2

Election period tolling for applicants because of an emergency declared by the state or federal government

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This policy governs when the PEBB Program may pause, delay, or suspend enrollment, annual open enrollment, or special open enrollment election periods for an applicant affected by a qualifying state or federal emergency.

Policy Summary

PayerWashington State Health Care Authority

PolicyElection period tolling for applicants because of an emergency declared by the state or federal government

Policy CodePolicy 57-2

Change TypeNo material change

Effective DateJanuary 1, 2027

Next Review DateNot specified

Key ActionSubmit a written tolling request and supporting documentation within 120 days after the deadline being tolled.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

120 daysRequest submission deadline

BalanceRestored election time

20 daysExample of additional election time

RetroactiveTimely post-tolling coverage

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CurrentWashington State Health Care AuthorityPolicy 57-2

Election period tolling for applicants because of an emergency declared by the state or federal government

Customize your policy alerts

Sign up for Washington State Health Care Authority Policy 57-2 alerts

Get alerted when Policy 57-2 changes without checking for updates manually.

Monitor payer policy activity

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Policy Summary

PayerWashington State Health Care Authority

PolicyElection period tolling for applicants because of an emergency declared by the state or federal government

Policy CodePolicy 57-2

Change TypeNo material change

Effective DateJanuary 1, 2027

Next Review DateNot specified

Key ActionSubmit a written tolling request and supporting documentation within 120 days after the deadline being tolled.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

120 daysRequest submission deadline

BalanceRestored election time

20 daysExample of additional election time

RetroactiveTimely post-tolling coverage

Post-taxRetroactive premiums

Emergency Election Period Tolling

Eligibility for emergency election period tolling

An applicant may receive emergency-related election period tolling when all applicable eligibility, documentation, and timing requirements are met.

ALL of the following

Qualifying emergency
- A state of emergency was declared by the Governor of Washington State under chapter 43.06 RCW.
- A federal emergency was declared under 44 C.F.R. Part 206, Subpart B, and the IRS recognizes the emergency for purposes of delaying deadlines.
The emergency prevented the applicant from making a timely enrollment, annual open enrollment, or special open enrollment election.
The applicant provides a statement describing the emergency impact and supporting documents explaining why the election could not be made during the election period.
The written request is received by the PEBB Program no later than 120 days after the deadline sought to be tolled.no later than 120 days
If a legal representative or another party acts on behalf of the applicant, proof of legal representation or guardianship, or other required supporting documentation, is provided within the applicable 120-day period.within 120 days
If the emergency caused mental or physical impairment or incapacity, the applicant meets the tolling requirements in PEBB Program Administrative Policy 56-2.

Consequences of approved tolling

After approval, the election period is paused for the documented period of emergency impact and the applicant may use the remaining election time.

ALL of the following

Tolling begins on the date the state or federal emergency started to impact the applicant.
The remaining election period begins to run when applicable
- The applicant is no longer impacted by the emergency.
- The emergency ends.
- Legal representation or guardianship is established, as demonstrated by supporting documentation.
- A party acting on behalf of the applicant began acting on the applicant's behalf.

Appeal of denial

A denied tolling request may be challenged through the specified PEBB appeal process.

The applicant or another party acting on the applicant's behalf may appeal a denied tolling request to the PEBB Appeals Unit by following the process described in WAC 182-16-2030.

Key Tolling and Coverage Rules

Tolling Request Submission

Submission deadlineThe written tolling request must be received by the PEBB Program no later than 120 days after the deadline the applicant is requesting be tolled.

Required documentationSupporting documentation explaining the emergency impact and why the applicant could not make an election must be submitted with the request.

Representation documentationDocumentation of legal representation or guardianship must also be received no later than 120 days from the deadline being tolled.

Restored Election Time

Restored election timeThe applicant or legal representative receives the balance of the election period remaining when the emergency started to impact the applicant.

Tolling startThe election period is tolled from the date the state or federal emergency started to impact the applicant.

Operational Processing Requirements

Documentation Required

Evaluate tolling eligibility

The PEBB Program must determine whether the applicant qualifies for election period tolling. Review whether a qualifying state or federal emergency occurred, the IRS recognizes a federal emergency for delaying deadlines, the emergency prevented a timely election, and the applicant submitted the required statement and supporting documentation.

Documentation Required

Receive a timely written request and documentation

The applicant or legal representative must submit a written tolling request with supporting documentation, received by the PEBB Program no later than 120 days after the deadline being tolled. Documentation showing the emergency’s impact and why the applicant could not make the election must be submitted with the request.

Receive the written request and supporting documentation within the 120-day deadline.
Apply the same 120-day receipt deadline to documentation of legal representation or guardianship.

Policy Terms

Tolling or Tolled

MeaningTolling or tolled means to pause, delay, or suspend the time period to make an election.

Enrollment electionsThe definition applies to electing enrollment, annual open enrollment, or special open enrollment.

EffectWhile tolled, the time period to make the election is no longer running.

Qualifying Emergency

State emergencyAn emergency declared by the Governor of Washington State under chapter 43.06 RCW.

Federal emergencyAn emergency declared under 44 C.F.R. Part 206, Subpart B, that the IRS recognizes for purposes of delaying deadlines.

Policy Summary

PayerWashington State Health Care Authority

PolicyElection period tolling for applicants because of an emergency declared by the state or federal government

Policy CodePolicy 57-2

Change TypeNo material change

Effective DateJanuary 1, 2027

Next Review DateNot specified

Key ActionSubmit a written tolling request and supporting documentation within 120 days after the deadline being tolled.

SourceLink

On This Page

If the applicant's legal representative was already on file with the HCA and was also impacted by the emergency, the legal representative is no longer impacted or a new legal representative is established.

The applicant makes the election within the remaining balance of the tolled election period.

Coverage begins retroactively on the date of the qualifying event, contingent on payment of any unpaid premiums and unpaid applicable premium surcharges; all retroactive premiums are paid post-tax.

Illustrative balanceIn the policy example, an emergency impact from day 25 through day 45 restores 20 days of election time.

Retroactive Coverage Condition

Timely electionThe election must be made within the balance of the tolled election period—the time remaining after the election period is no longer paused, delayed, or suspended.

Premium paymentPayment of any unpaid premiums and unpaid applicable premium surcharges is required.

Coverage effective dateWhen these conditions are met, coverage begins retroactive to the date of the qualifying event.

Tax treatmentAll retroactive premiums are paid post-tax.

Documentation Required

Verify legal representation

When a legal representative requests tolling on the applicant’s behalf, require proof of the legal representation. Documentation of legal representation or guardianship must be received by the PEBB Program no later than 120 days from the deadline the applicant is asking to toll.

Billing Rule

Apply approved tolling

Upon approval, pause the election period beginning on the date the state or federal emergency started to impact the applicant. Preserve and provide the applicant or legal representative the balance of the election period after tolling ends.

Billing Rule

Restart the remaining election period

Restart the balance of the tolled election period when the applicant is no longer impacted by the emergency, the emergency ends, or legal representation or guardianship is established, as demonstrated by supporting documentation. For a party acting on behalf of the applicant, the remaining period begins on the date that party began acting; if an existing legal representative is impacted, it begins when that representative is no longer impacted or when a new representative is established.

Billing Rule

Process a timely election and retroactive coverage

If the election is made within the remaining tolled election period, begin coverage retroactively on the date of the qualifying event. Retroactive coverage is contingent on payment of unpaid premiums and applicable unpaid premium surcharges; all retroactive premiums are paid post-tax.

Denial Risk

Handle denied tolling requests

If a tolling request is denied, direct the applicant or another party acting on the applicant’s behalf to appeal the denial to the PEBB Appeals Unit by following the process described in WAC 182-16-2030.

The emergency must prevent the applicant from making a timely election.

Balance of the Tolled Election Period

DefinitionThe balance of the tolled election period is the period remaining for the applicant to make an election after the tolling pause, delay, or suspension ends.

When it begins to runThe remaining period begins when the applicant is no longer impacted by the emergency, the emergency ends, or legal representation or guardianship is established, as demonstrated by supporting documentation.

Party acting on behalfFor a party acting on behalf of the applicant, the remaining period begins on the date that party began acting on behalf of the applicant.