HIPAA Q&A

What is HIPAA?
The Health Insurance Portability and Accountability Act of 1996, commonly known as HIPAA, sets forth new responsibilities for the plan sponsors of group health plans, including self-funded medical plans. Among these responsibilities, HIPAA aims to simplify insurance portability by documenting limitation periods for pre-existing conditions. To that end, covered individuals receive credit for time completed during the limitation period – credit that can be carried over to a new plan should the individual change jobs or otherwise lose coverage.

Under HIPAA, how are covered individuals credited for time completed?
When an employee or dependent loses health insurance coverage, the former employer of health insurer must supply a “certificate of creditable coverage”. The certificate documents the amount of creditable coverage fulfilled under the previous plan, and must be given to the next employer or insurer.

MedBen offers two types of HIPAA administration services: standard, which includes notification to employees of pre-existing condition limitations in addition to preparation and distribution of certificated of creditable coverage; and limited, certificate-only service, for employers or insurers who wish to handle HIPAA administration themselves.

Standard Administration Service  

• Preparation and distribution of certificates of creditable coverage. (The previous employer or insurer is responsible for ensuring that the certificate reaches the employee’s and/or dependent’s last known address.)

• Acceptance and investigation of any certificates of creditable coverage presented to the new employer or insurer as proof of prior creditable coverage (including evidence received in a form other than a standard certificate).

• Preparation of the initial notice to employees and dependents regarding the use of a pre-existing condition limitation in the group’s health plan and the application of creditable coverage in reducing the limitation period.

• Preparation of personalized pre-existing condition limitation notices. Each such notice will be prepared on behalf of any employee and/or dependent(s) who are subject to a limitation period under the group’s health plan.

Standard service customers also receive MedBen COBRA administration at no additional cost. To learn more about MedBen COBRA, click here.

Certificate Only Service

• Acceptance of requests for certificates of creditable coverage from the employer, the insurer, the agent, the covered individual, or a representative of any of these, either in writing or over the telephone. (The employer or insurer will be billed monthly, and will be financially responsible, for every request that requires a certificate, regardless of its origin.)
• Preparation and distribution of certificates of creditable coverage. (The previous employer or insurer is responsible for ensuring that the certificate reaches the employee’s and/or dependent’s last known address.)

For more information about HIPAA administration, e-mail our marketing department at marketing@medben.com.