Health Insurance Portability & Accountability Act

Alice1

I am trying to get the "Certification of Prior Coverage" form that the insurance carrier of the group health plan issues to an individual stating the length of time the individual has been covered.

If I understand it right,if an employee has a pre-existing condition, the new carrier cannot deny immediate coverage if the employee has been covered for 12 months.

Don D

Alice: The rule says that looking at the past 12 months, the person can not have had a break in coverage of over 63 days. The certification from the prior carrier verifies this for you (or not). The prior carrier is responsible for providing the person with a certificate of prior coverage which has the information in it. All insurance companies are supposed to have the forms and are required to provide them if requested to do so. If there is a break in coverage of more than 63 days, the succeding insurance plan will be allowed to consider pre-existing conditions to be exclusions for the next 12 months. The breaks in coverage I have generally encountered come when an employee is out of work and doesn't elect COBRA, thus has no coverage for a period of time between jobs. Don D.

Alice1

Thank you for the reply. Your last sentence was also a question that I had and has now been answered.
Alice