The HIPAA portability provision, as the name implies, is designed to improve the portability of health coverage for people who are changing jobs and to make it easier to add family members to an employees’ coverage. HIPAA portability applies to group health plans and issuers of group health plans. So both the employer and the insurer are obligated to comply.
Certificate of Creditable Coverage
Part of the HIPAA portability provision is issuing a Certificate of Creditable Coverage (COCC). The COCC must indicate the date that any waiting period began and the dates that coverage under the plan began and ended. On the back of the COCC is educational information explaining HIPAA rights. PHP issues a COCC:
- when regular coverage is lost;
- when COBRA coverage is lost;
- when a COCC is requested by a member while still active; and
- within two years after losing coverage.
After termination of coverage, if a member is moving to another health plan that has a pre-existing condition exclusion (PCE), the timeframe reflected on the COCC can be used to reduce the PCE period by one day for every day of creditable coverage listed on the COCC.
HIPAA requires a group health plan to provide a special enrollment opportunity to employees and their dependents under certain circumstances. A few examples of these circumstances are listed below.
If the employee and or dependent did not enroll in the plan because they had other coverage and requested special enrollment within 30 days, they would be eligible for special enrollment when:
- they lost coverage because they lost eligibility;
- the employer contributions for the coverage ceased;
- the COBRA period of 18, 29, or 36 months was exhausted; or
- an employee acquires a new spouse or dependent by marriage, adoption, placement for adoption or birth. The special enrollment right applies to the employee, the employee’s spouse and the newly acquired dependent.
If coverage is gained or lost under a Medicaid or CHIP Program, the special enrollment period is 60 days.
Department of Labor resources for more HIPAA Portability information: