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    v1.0.31
    OpenPayerPolicy UpdatesAdministrative/Operational PolicyWashington HCA Tolling Policy Update | OpenPayer
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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

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    Establishes how the SEBB Program evaluates requests to pause, delay, or suspend enrollment election periods when a qualifying state or federal emergency prevents a timely election.

    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 DateJan 1, 202749d
    Next Review DateNot specified
    Key ActionRequire a written tolling request and supporting documentation to be received by the SEBB Program no later than 120 days after the deadline the applicant seeks to have tolled.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    120 daysRequest submission deadline
    BalanceRemaining election period after approval
    RetroactiveCoverage timing after timely election
    WrittenRequired request format

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    AvailableAppeal of denied request

    Emergency Election-Period Tolling Criteria

    Eligibility for emergency election-period tolling

    An applicant or the applicant’s legal representative may request tolling when all applicable eligibility requirements are met.

    ALL of the following

    • ONE of

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

      • ALL of the following

        • A federal emergency is declared under 44 C.F.R. Part 206, Subpart B.
        • The Internal Revenue Service recognizes the federal emergency for purposes of delaying deadlines.
    • The emergency impacted the applicant and prevented the applicant from making a timely election.
    • The applicant provides a statement describing the emergency impact, with supporting documentation showing the impact and explaining why the applicant could not make an election during the election period.

    • If applicable

      • When the request is submitted by a legal representative, the legal representative provides proof of legal representation.
      • When the emergency caused mental or physical impairment or incapacitation, the applicant meets the tolling requirements in SEBB Program Administrative Policy 56-2.
    • The written request and supporting documentation are received by the SEBB Program no later than 120 days after the deadline the applicant or representative is requesting be tolled.Within 120 days

    Effects of approval, denial, and timely election

    If tolling is approved, the applicant receives the remaining election period after the qualifying impact ends. A timely election may result in retroactive coverage, subject to payment requirements.

    If tolling is approved

    • Tolling begins on the date the federal or state emergency started to impact the applicant.
    • The remaining election period begins to run when the applicant is no longer impacted by the emergency, the emergency ends, legal representation or guardianship is established, or a party begins acting on behalf of the applicant, as applicable.
    • If an already-filed legal representative is also impacted, the remaining tolled period begins when that representative is no longer impacted or when a new legal representative is established.
    • The election is made within the remaining balance of the tolled election period.

    Submission and Election-Period Timing

    Tolling request submission deadline
    Submission formatWritten request with supporting documentation
    Submission deadlineWithin 120 days after the deadline the applicant or representative is requesting be tolled
    Representation documentationProof of legal representation must be submitted when a legal representative makes the request
    Restart of remaining election period
    Applicant no longer impactedThe balance of the tolled election period begins when the applicant is no longer impacted by the emergency
    Emergency endsThe balance begins when the emergency ends

    Administrative Processing Requirements

    Documentation Required

    Determine tolling eligibility

    Evaluate whether the applicant or legal representative demonstrates that a qualifying Washington state or federal emergency prevented a timely election. Review the applicant’s statement and supporting documentation, and apply the requirements in SEBB Program Administrative Policy 56-2 if the emergency caused mental or physical impairment or incapacitation.

    Documentation Required

    Collect timely request and representation documentation

    Require a written tolling request and supporting documentation to be received by the SEBB Program no later than 120 days after the deadline the applicant or representative is requesting be tolled. When a legal representative submits the request, require proof of legal representation by the same deadline.

    • The supporting documentation must show the emergency’s impact and explain why the applicant could not make an election during the election period.
    • Documentation of legal representation must be received no later than 120 days from the deadline being tolled.

    Key Terms

    Tolling or tolled
    DefinitionTo pause, delay, or suspend the time period to elect enrollment, annual open enrollment, or special open enrollment
    Applies toEnrollment, annual open enrollment, and special open enrollment election periods
    EffectThe election period is no longer running while it is paused, delayed, or suspended
    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
    IRS recognition
    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 DateJan 1, 202749d
    Next Review DateNot specified
    Key ActionRequire a written tolling request and supporting documentation to be received by the SEBB Program no later than 120 days after the deadline the applicant seeks to have tolled.
    SourceLink
    On This Page
    Emergency Election-Period Tolling CriteriaSubmission and Election-Period TimingAdministrative Processing RequirementsKey Terms
    Coverage begins retroactive to the date of the qualifying event.
  1. Any unpaid premiums and unpaid applicable premium surcharges are paid; all retroactive premiums are paid post-tax.
    2. If tolling is denied, the applicant or another party acting on the applicant’s behalf may appeal the denial to the SEBB Appeals Unit by following the process described in WAC 182-32-2030.

    Appeal available for a denied tolling request.

    Representation or guardianship established
    The balance begins when legal representation or guardianship is established, as demonstrated by supporting documentation
    Party begins actingWhen a party acts on behalf of the applicant, the balance begins on the date that party began acting
    Billing Rule

    Calculate and administer the tolled period

    Upon approval, pause the election period from the date the emergency started impacting the applicant. Restart the remaining balance when the applicant is no longer impacted, the emergency ends, legal representation or guardianship is established, or a party begins acting on the applicant’s behalf, as applicable.

    • Use supporting documentation to establish the applicable restart date.
    • The applicant or legal representative receives the balance of the election period to make the election.
    Billing Rule

    Process retroactive coverage and premiums

    When an election is made within the remaining tolled period, begin coverage retroactive to the date of the qualifying event, contingent on payment of unpaid premiums and applicable unpaid premium surcharges. All retroactive premiums are paid post-tax.

    Denial Risk

    Provide denial appeal pathway

    If tolling is denied, inform the applicant or another party acting on the applicant’s behalf that the denial may be appealed to the SEBB Appeals Unit by following the process described in WAC 182-32-2030.

    For a federal emergency, the Internal Revenue Service must recognize the emergency for purposes of delaying deadlines
    Required impactThe emergency must prevent an applicant from making a timely election