HIPAA Administration

HIPAA was enacted in 1996 to reduce the number of individuals who change jobs and may not have access to health coverage. These individuals may have claims denied due to preexisting condition limitations within insurance contracts. Prior to HIPAA, an individual who was terminated from employment would have to satisfy a period of time (typically from 3 to 12 months) before claims due to preexisting conditions would be covered.
HIPAA allows these individuals to reduce or eliminate this preexisting condition limitation by providing proof of past coverage to the new insurer. For example, if an employee is terminated after being employed (and covered) for 24 months, the 6 month preexisting condition limitation in a new employer plan is entirely waived. The employee must prove to the new employer the 24 months of prior coverage. HIPAA requires that all employers provide this Certificate upon loss of coverage. The individual must deliver this Certificate of Creditable Coverage to the new employer.

In conjunction with our COBRA administration services, Benefit Express will provide the Certificate of Creditable Coverage at the time of loss of coverage. Although the law requires certain basic reporting requirements, we have determined that the following process is needed to effectively determine when coverage should be applied by the new insurer.

The Benefit Express Certificate Process

• Issued at the time of a qualifying event
• Issued at the time of COBRA termination or expiration
• Issued at request of an individual or health care provider
• Mailed via ESOPs Proof of Mailing
• Archived documentation maintained to prove compliance
• Toll-free call center assistance

Our HIPAA services, in conjunction with our COBRA services, provide a total solution that greatly relieves the administration burden with the associated complicated legal requirements.

For additional information about how Benefit Express can assist your company, please contact us by clicking here or call us at 1.877.837.5017.