Proposed regulations issued under the Affordable Care Act would eliminate the requirement to provide a HIPAA Certificate of Creditable Coverage when a participant terminates coverage under a group health plan. A group health plan or health insurance issuer provides a certificate of creditable coverage to a participant to document the duration of a participant’s health coverage. Presently, a certificate must be issued when coverage is lost under a group health plan, when an individual is entitled to elect COBRA continuation coverage, and when COBRA coverage ends. The certificate shows the individual’s most recent period of creditable health coverage.
Before health care reform, plans could impose pre-existing condition limitations on new enrollees. Prior creditable coverage could off-set a pre-existing condition limitation. Participants documented prior creditable coverage by producing a HIPAA certificate.
Health care reform eliminates pre-existing condition limitation exclusions for plan years beginning on or after January 1, 2014. At that time, HIPAA certificates of creditable coverage will no longer be necessary. If finalized, the regulations would eliminate the requirement to provide a HIPAA certificate as of December 31, 2014. The certificate must be provided until this date to take into account the possibility of lingering pre-existing condition limitation exclusions in non-calendar year plans.