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Certificates of Creditable Coverage No Longer Required Under HIPAA

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Certificates of Creditable Coverage were required by health plan providers and issuers under the Health Insurance Portability and Accountability Act (HIPPA); however the issuing of a final rule of the Affordable Care Act (ACA) changes the requirements of other healthcare regulations such as HIPAA. As a result, Certificates of Creditable Coverage are no longer required for new health plans or any issued since January 1st, 2014.

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

From 1st January, 2014 until 31st December, 2014, health plan providers have not been able to impose pre-existing conditions exclusions on enrollees in health plans and as of 1st January 2015, Certificates of Creditable Coverage will no longer be required to be issued, as previously mandated by HIPAA.

However, for any plans that began before 1st January, 2014, limited 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 period of 24 months after coverage has terminated.

It is essential that health plan providers and issuers keep fully up to data with the changes to HIPAA regulations, as well as any legislative changes that amend HIPAA, to ensure full compliance is maintained.

Any HIPAA covered entity discovered to have violated data Privacy and Security Rules can face stiff financial penalties from the Office for Civil Rights and Attorney General’s Offices for non-compliance issues, and victims of data breaches can potentially file negligence lawsuits against organizations responsible for neglectfully exposing protected health data.

Author: HIPAA Journal

HIPAA Journal provides the most comprehensive coverage of HIPAA news anywhere online, in addition to independent advice about HIPAA compliance and the best practices to adopt to avoid data breaches, HIPAA violations and regulatory fines.

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