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How does a new employer or insurance carrier know that an employee had prior group coverage?

April 26, 2017coverage employee employer group Insurance prior

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How does a new employer or insurance carrier know that an employee had prior group coverage?

7 Answers

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Group health plans and health insurance issuers are required to provide a certificate of coverage to an individual for documentation of prior creditable coverage. A certificate of creditable coverage shall be provided automatically by the plan or issuer when an individual either loses coverage under the plan or becomes entitled to elect COBRA continuation coverage and when an individual’s COBRA continuation coverage ceases and shall also be provided, if requested, before the individual loses coverage or within 24 months of losing coverage.

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Proof of prior coverage will be necessary; the member should contact the customer service department of the prior health plan to request a certificate of creditable coverage. A copy of this certificate should be submitted to the employer and/or the new insurance carrier.

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A36. Group health plans and health insurance issuers are required to provide a certificate of coverage to an individual for documentation of prior creditable coverage. A certificate of creditable coverage shall be provided automatically by the plan or issuer when an individual either loses coverage under the plan or becomes entitled to elect COBRA continuation coverage and when an individual’s COBRA continuation coverage ceases and shall also be provided, if requested, before the individual loses coverage or within 24 months of losing coverage. Blue Cross’ POS plans do not include preexisting condition exclusions.

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Mutual of Omaha enrollment forms request that Other Insurance information be provided by the employee. If the employee does not provide this information at time of enrollment, it will be questioned by the claims department at the time of claim submission and review.

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Group health plans and health insurance issuers are required to provide a Certificate of Coverage to an individual who was formerly covered under one of their plans for documentation of prior creditable coverage. A Certificate of Creditable Coverage shall be provided automatically by the plan or issuer when an individual either loses coverage under the plan or becomes entitled to elect COBRA continuation coverage and when an individual’s COBRA continuation coverage ceases and shall also be provided, if requested, before the individual loses coverage or within 24 months of losing coverage.