|
Effective: February 1, 2009 |
|
|
15.20ar3 - Creditable Coverage (Archive) |
Archived: August 1, 2009 |
The Health Insurance Portability and Accountability Act (HIPAA) includes rights and protections for participants in group health plans. These rights and protections:
l Limit exclusions for preexisting conditions.
l Prohibit discrimination against employees and dependents based on their health status.
l Allow a special opportunity to enroll in a new plan to individuals in certain circumstances.
To be eligible under these rights and protections, client must provide information to employers and group health plans of previous creditable coverage when they move between health plans. This section provides information on creditable coverage.
More HIPAA information is available on the Center for Medicare and Medicaid Services' (CMS) website.
Certificates of Creditable Coverage.
Creditable coverage gives people credit for previous health insurance coverage when they move between health plans. People may move between employer groups and individual policies.
Most health care coverage is considered creditable coverage, including:
l Group or individual health plans.
l Medicare.
l Medical Assistance (MA).
l General Assistance Medical Care (GAMC).
l Emergency Medical Assistance (EMA).
l MinnesotaCare.
l TRICARE (CHAMPUS).
l Indian Health Service.
l Minnesota Comprehensive Health Association (MCHA).
l Federal Employees Health Benefit Program.
l Peace Corps member health plans.
Another type of creditable coverage involves drug coverage and Medicare Part D.
Creditable drug coverage for Medicare Part D purposes means the drug coverage in a client’s current health care coverage is the same or better than coverage provided under the Medicare Part D benefit.
People who are full-benefit dual eligibles and have prescription drug coverage, such as through an employer or union as an employee or retiree, may choose to decline Medicare Part D and keep that coverage without penalty if it is creditable drug coverage.
l Creditable drug coverage may be provided by the following:
n Employer plan.
n Employer or union retiree plan.
n Veteran’s health care benefits.
n Federal Employees Health Benefit Plan.
n TRICARE (CHAMPUS).
n Private insurance.
l Group health insurance providers are required to notify clients whether the drug coverage through the plan qualifies as creditable drug coverage for Medicare Part D. Clients may request this information for new policies.
l People with creditable drug coverage need to consider:
n There may be consequences if they drop their group drug coverage.
n If they drop employer or union coverage they will probably not be able to get it back.
n They may not be able to drop just the drug coverage. They could risk losing access to their health care coverage.
n Any drug copays or other drug cost-sharing required under the group plan will not be paid by MA or GAMC.
n Maintaining enrollment in both Medicare Part D and a group drug coverage plan may result in involuntary disenrollment from the group plan.
People with creditable drug coverage should contact their employer or benefit administrator for more information before making a decision about their drug coverage.
See the following for more information on how Medicare Part D affects MHCP eligibility.
l Cost-Effective Health Care Coverage - MA and GAMC.
Certificates of Creditable Coverage
A certificate of creditable coverage (COCC) is proof of past creditable coverage.
l DHS automatically issues Certificates of Creditable Coverage (COCCs) two months after MinnesotaCare, MA, GAMC, and EMA close. Clients may need the certificates to enable them to enroll in other health care coverage plans.
l Clients may request a COCC before MinnesotaCare, MA, GAMC or EMA eligibility ends and up to 24 months after the eligibility end date.
Clients may call (651) 431-3205 or (800) 657-3762 (Option 4).
Submit the following to DHS to when a client requests a COCC:
n Client's full name.
n Current mailing address.
n Names of dependents needing certificates.
n PMI number for each person requesting a COCC.
n Send the request to DHS using one of these methods:
m Mail to:
Finance and Administrative Support Office - COCC.
Department of Human Services.
P. O. Box 64993.
St. Paul, Minnesota 55164-0993.
m Send via DHS Interoffice mail: Mail code ”0993.”
m Fax: (651) 431-7436.
m Call: (651) 431-3205 or (800) 657-3762 (Option 4).
m E-Mail: DHS.COCC@state.mn.us.