Up until now, HIPAA rules have required that Certificates of Creditable Coverage (also known as HIPAA Certificates) be automatically sent out to members when their coverage ends. This rule was in place to protect people who changed jobs so that they could show continuity of coverage and avoid pre-existing conditions limits. However, since the Affordable Care Act (ACA) has eliminated pre-existing condition limits, the ACA final regulations amend the HIPAA requirement that health plans send these certificates to terminating members.
However, there are situations where these certificates will still be needed, such as when someone looses coverage due to a qualifying event and needs to move on to his or her spouse’s plan outside of their open enrollment. Members who need a certificate as proof that they lost coverage will need to call their health plan’s member services to request one. It generally takes about two weeks for certificates to be printed and mailed, depending on the carrier.
Small group health plans in Massachusetts will see a change in the way rates are provided upon renewal in 2015. Due to federal health care reform, all small group health plans will be provided on a 4 tier rate basis, including rates for Singles, Couples, Employees with Children and Families. Two and three tier rates will no longer be offered to small groups, defined as businesses with 50 or fewer benefit-eligible employees.
The calculations to convert the premium to four tiers is premium-neutral, so companies that currently have two tier rates and enroll only singles and families should not see a significant jump in the family rate.
This change does not affect dental plans, even if the health and dental plans are provided by the same carrier.
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