What if a participant is unable to provide a Certificate of Creditable Coverage to the new group health plan?
A. HIPAA provides special rules for participants to demonstrate Creditable Coverage when: • either a carrier or former employer has failed to provide a certification in a timely manner; or • the carrier or former employer for some reason is exempt from the HIPAA regulations; or • the coverage is for a period prior to July 1, 1996; or • the participant has lost the Certificate and is unable to obtain another copy in a timely manner; or • the participant has an urgent medical condition that necessitates a determination before the participant can deliver a Certificate to the Plan. Under these circumstances the participant must be allowed to demonstrate Creditable Coverage through presentation of documents, records, third party statements or by other means. The participant must attest to the period of Creditable Coverage and cooperate with the plan effort to verify coverage. Q.
Related Questions
- If a group health plan does not provide any dependent coverage, may the NMSN require the plan to provide for a child of a participant pursuant to a QMCSO?
- What if a participant is unable to provide a Certificate of Creditable Coverage to the new group health plan?
- Can an employer or group choose not to offer coverage to qualified dependents through their health plan?
