Understanding a

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By Tony Novak, MBA, MT, accountant, www.tonynovak.com, OnlineAdviserTM at MedSave.com

A "Certificate of Creditable Coverage" (abbreviated as "Certificate" in this article) is a creation of the federal Health Insurance Portability and Accountability Act designed to ensured that individuals who change health insurance plans will enjoy continuous coverage for ongoing medical treatments. Without this federal law, new enrollees in a health plan might be subject to a waiting period before coverage is offered for pre-existing medical conditions under a new group insurance plan and this could be deterrent for employees who want to change jobs.

The Certificate program provides that once you have been continuously insured for 18 months, there is no need to satisfy another waiting period for benefits. A gap in coverage of less than 60 days does not jeopardize the "continuous coverage" but it is important to maintain a personal short term medical insurance plan if there is going to be a gap of more than two months between group plans.

The Certificate program is designed to be largely automated and require little effort on the part of health plan members. Certificates are automatically generated by every health insurance plan within a few weeks of a member's termination. If you do not receive a Certificate by mail within 30 days of termination, contact the insurer and verify your mailing address. Certificates are not yet available electronically, but most health insurance companies are now developing this additional service. When you receive his certificate, simple forward a copy to your health insurance company while keeping a copy for our own records. You might want to store the certificate inside the cover of the new health insurance policy itself for easy reference later.

Certificates are not useful for the purpose of obtaining coverage for pre-existing conditions when enrolling in a health plan that never offers this benefit in any circumstance. Short term medical insurance policies fall under this category; they never cover pre- existing medical conditions. Also be aware that many of the lower cost individual health insurance plans are available to individuals without significant pre-existing medical conditions. In this case, if you are not eligible for coverage under a specific plan, of course, you will not benefit from the availability of a Certificate. There is some common misconception that a person with a Certificate is eligible for any health insurance plan they may choose with a full take-over benefit for pre-existing conditions. This is simply not the case.

Certificates are not necessary when an entire business changes health plans. Generally group health insurance plans are issued with full takeover benefits for all eligible members on the date that the plan starts. Certificates are requested for those who join at a later date and want take-over benefits.

Finally, be aware that the federal law regarding Certificates is completely unrelated to specific state laws designed to address similar issues regarding take-over benefits and eligibility for insurance. Federal benefit laws override state laws in the event that there is a conflict in the application of the rules. Since these specific issues vary from state-to-state they are not addressed in this article. See your benefits adviser or ask your health insurance company for a list of state-specific mandates that apply in your situation.

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