HIPAA No Longer Requires Certificates of Creditable Coverage

Certificates of Creditable Coverage were necessary for health plan providers and insurers under the Health Insurance Portability and Accountability Act (HIPAA); however the publication of a final rule of the Affordable Care Act (ACA) has altered that requirement. Due to this, Certificates of Creditable Coverage are no longer required for new health plans or any issued since January 1, 2014.

Continuous coverage is ensured by HIPAA legislation for retirees taking advantage of the Consolidated Omnibus Budget Reconciliation Act (COBRA) as well as people who change employment or health plan policy. To help offset a preexisting condition exclusion as part of a new health plan, administrators were asked to issue a Certificate of Continuous Coverage 30 days prior to the end of coverage or 30 days before employment was in the past.

From January 1, 2014 until December 31, 2014, health plan subscribers have not been able to impose pre-existing conditions exclusions on enrollees in health plans and as of January 1 2015, Certificates of Creditable Coverage will no longer be necessary as they previously were under HIPAA.

However, for any plans that began prior to January 1 , 2014, restricted exclusions on pre-existing conditions may be placed and HIPAA Certificates should still be issued when coverage is lost. These certificates must also be issued on request for a duration of 24 months after coverage has terminated.

Any HIPAA covered group found to have violated HIPAA Rules can face stiff financial penalties from the Office for Civil Rights (OCR)  and state attorneys general. It is therefore vital that health plan providers and insurers keep an eye for changes to HIPAA regulations, as well as any legislative changes that amend HIPAA, to ensure they are always HIPAA compliant.

HIPAA Violation Penalties

Most Common HIPAA Violations Causes