Certificates of Creditable Coverage Not Needed Any More Under HIPAA

Health plan providers and insurers have required Certificates of Creditable Coverage under the Health Insurance Portability and Accountability Act (HIPAA) Rules; however, following the release of the final rule of the Affordable Care Act (ACA), Certificates of Creditable Coverage are no longer a requirement. Beginning January 1, 2014, new health plans no longer require Certificates of Creditable Coverage.

The HIPAA legislation assures retirees of continuous coverage as per the Consolidated Omnibus Budget Reconciliation Act (COBRA) even for persons who switch career or health plan policy. To offset a preexisting condition exemption with a new health plan, administrators have previously been required to issue a Certificate of Continuous Coverage 30 days before coverage ends or 30 days prior to leaving employment.

From January 1, 2014 to December 31, 2014, health plan providers cannot enforce preexisting conditions exclusions on health plan enrollees and as of January 1, 2015, there is no need to issue Certificates of Creditable Coverage as was required by HIPAA in the past.

Nonetheless, all health plans that commenced prior to January 1, 2014 may have limited exclusions on preexisting conditions and would still require the issuance of HIPAA Certificates of Creditable Coverage if coverage is lost. Certificates should also be issued upon request for 24 months following the termination of coverage.

It is the responsibility of HIPAA covered entities to keep abreast of changes to HIPAA Rules and any other law changes that modify HIPAA. The failure to comply with changes to HIPAA requirements could potentially place a HIPAA covered entity at risk of a fine for noncompliance.