|
Effective: June 1, 2011 |
|
|
15.20ar5 - Creditable Coverage (Archive) |
Archived: September 1, 2011 |
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 for individuals to enroll in a new plan in certain circumstances.
To be eligible under these rights and protections, individuals 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.
The Medicare Modernization Act (MMA) includes requirements for creditable drug coverage.
Creditable coverage may be a factor in determining eligibility for Minnesota Health Care Programs (MHCP).
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 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.
l Stay Well, Stay Working: Minnesota’s Demonstration to Maintain Independence and Employment. See the DHS Web site for more information about this program.
The MMA establishes requirements for creditable drug coverage through 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. A person with creditable drug coverage may decline Part D without a penalty if they choose to enroll later.
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.
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.
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 eligibility closes for each person enrolled in MinnesotaCare, MA, EMA and Stay Well, Stay Working. Clients may need the certificates to enable them to enroll in other health care coverage plans.
l Clients may request a COCC before eligibility ends.
l Former MHCP clients may request a COCC regarding their MHCP coverage at any time.
Issue a COCC to any client or former client upon request. There is an MMIS process for this purpose; refer to the MMIS User Manual for complete instructions. Based on coding entered, MMIS will issue a COCC:
l for each person on a case. For minors, the COCC will be issued to the adult in the household.
l to the most recent address listed. Update the address, if needed.
l for any coverage that was open, even if coverage ended more than 24 months ago.