HIPAA certificate of creditable coverage (ß 701(e); 29 CFR 2590.701-5)
All group health plans.
Each certificate must include:
Name of plan;
Individual's name and ID;
Plan administrator name, address, and phone number;
Phone number for further information;
Individual's creditable coverage information; and
When the certificate is provided upon request, as soon as possible.
When the certificate is provided automatically upon loss of coverage and a COBRA qualifying event, not later than the end of the period for providing COBRA notice (generally 44 days).
When the certificate is provided automatically upon loss of coverage and not a COBRA qualifying event, within a reasonable time after coverage ceases (as soon as possible).
General notice of preexisting condition exclusion (29 CFR 2590.701-3(c))
Any group health plan that contains a preexisting condition exclusion.
The plan must disclose the existence and terms of any preexisting condition exclusion under the individual plan and the rights of individuals to demonstrate creditable coverage. This includes a description of the right of the individual to request a certificate from a prior plan or issuer and a statement that the current plan will assist in obtaining a certificate from any prior plan or issuer, if necessary.
Must be provided before a preexisting condition exclusion may be applied
Individual notice of preexisting condition exclusion (29 CFR 2590.701-5(d))
Group health plans that contain a preexisting condition exclusion, but only after receiving creditable coverage information from an individual that is not enough to offset the preexisting condition exclusion period.
This notice must include:
The plan's determination of the period of creditable coverage (note: the plan must allow the individual a reasonable opportunity to submit additional evidence of creditable coverage);
The remaining preexisting condition exclusion period that will apply to the individual; and
A description of any appeal procedures established by the plan or issuer.
Within a reasonable time of the presentation of creditable coverage by the individual.
Notice of special enrollment rights (29 CFR 2590.701- 6(c))
All group health plans.
A description of the plan's special enrollment rules.
On or before the time an employee is offered an opportunity to enroll in the plan.
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