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Certificates of Creditable Coverage No Longer Required Under HIPAA

Certificates of Creditable Coverage were required by health plan providers and insurers under the Health Insurance Portability and Accountability Act (HIPAA); however the issuing of a final rule of the Affordable Care Act (ACA) has changed that requirement. 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.

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Any HIPAA covered entity discovered to have violated HIPAA Rules can face stiff financial penalties from the Office for Civil Rights and state attorneys general. It is therefore essential that health plan providers and insurers keep fully up to data with changes to HIPAA regulations, as well as any legislative changes that amend HIPAA, to ensure they remain fully compliant.

Author: Steve Alder is the editor-in-chief of HIPAA Journal. Steve is responsible for editorial policy regarding the topics covered on HIPAA Journal. He is a specialist on healthcare industry legal and regulatory affairs, and has several years of experience writing about HIPAA and other related legal topics. Steve has developed a deep understanding of regulatory issues surrounding the use of information technology in the healthcare industry and has written hundreds of articles on HIPAA-related topics.