certificates of creditable coverage

[jeanine]

I seem to recall a previous thread that discussed this but I need someone to point me in the right direction. When a company that offers health insurance to its employees changes insurance companies, are there any certificate of creditable coverage obligations by any party? I say no cert of creditable coverage, because coverage is not lost. The new insurance company is requesting for pre-ex purposes. Can't they get this information from the employer without a cert?

[papogi]

HIPAA does not require that an insurance company or TPA send out HIPAA certs which vouch for any more coverage than their system itself proves. When an employee terms off of the plan under your new insurance company, the carrier is only required to send out a HIPAA cert showing the coverage under that carrier or TPA. Without a cert from the previous carrier, things will get messy. The previous carrier should produce HIPAA certs. The new carrier can require certs, although HIPAA does not require this. Under HIPAA, other forms of proof of coverage are acceptable (even a documented phone call to an employer), so I would think that some sort of verification from the employer would suffice. You’ll have to work that out with the new carrier. Either way, if the new carrier won’t produce certs which vouch for coverage prior to their involvement, then your previous carrier does need to get certs in the hands of the participants.