HIPAA Notice of Creditable Coverage

Under the Health Insurance Portability and Accountability Act, group health plans and insurers are required to furnish a statement of prior health coverage, commonly referred to as a “certificate of coverage” to provide documentation of the individual’s prior creditable coverage.

This certificate must be provided in the following circumstances:

• Automatically when an individual loses coverage under the plan
• Automatically when an individual becomes entitled to elect COBRA continuation coverage, at a time no later than when notice is required under COBRA;
• Automatically within a reasonable period of time after the plan learns that COBRA continuation coverage has ceased or after the individual’s grace period for the payment of COBRA premiums ends; and
• Upon request, before an individual loses coverage or within 24 months of losing coverage.

Group health plans and insurers that fail or refuse to provide certificates of coverage are subject to penalties under HIPAA. A group health plan may contract with its insurer or third party administrator to provide the certificates.

The federal Department of Labor has developed a model Certificate of Group Health Plan Coverage.