HIPAA Certificate Requirements

The HIPAA (Health Insurance Portability and Accountability Act) provides a certificate, known as certificate of creditable coverage, documenting previous health coverage a person or person's dependent had prior to changing or losing their present coverage. They may be mailed to the person's home and are usually received a few weeks after present coverage ends. If you lose the original certificate, you can usually request another within the first 24 months after coverage has ended.

What Does HIPAA Offer

• The Health Insurance Portability Act can improve the portability of health care coverage which can greatly improve the chances of getting new coverage more quickly. It does not guarantee that an employer will provide any health care coverage. HIPAA may limit exclusions for preexisting medical conditions (illnesses or diseases that may have occurred in the past and may or may not remain under treatment). Prior to HIPAA these preexisting conditions may have resulted in a 6-12 month wait for those conditions to be covered by the new insurance.

What HIPAA Does Not Offer

• Under HIPAA, a new employer's plan must give individuals credit for the length of time they had prior continuous health coverage. However, if there is a break in coverage of 63 days or more, thereby reducing or eliminating the 12-month exclusion period of coverage, HIPAA does not offer any other options for inclusion of the preexisting conditions. For example, if an employee remains out of work for a period of time and during that time there is no coverage for 63 days, the preexisting conditions may be excluded in the new coverage with a waiting period. In addition, it does not guarantee that any conditions you now have or had in the past are covered by your new employer's health plan. It also cannot prevent an employer for from imposing a preexisting condition exclusion period if you have been treated for a preexisting condition during the past 6 months

HIPAA Certificate Requirements

• Certificates of creditable coverage will contain information about such things as the length of time the person or person's dependents had coverage. The certificate also contains information about each period of continuous coverage that occurred within the 24 months before the lost eligibility. It will contain the names, addresses, and social security numbers of persons who were covered under the particular health plan, dates of coverage, date of coverage end, and date of certificate issue.

Who Manages HIPAA

• The U.S. Department of Health & Human Services is the watchdog for HIPAA and provides a wealth of information regarding consumer rights and more detailed information regarding the act.