Proposed regulations published on March 21, 2013 addressed not only the 90-day waiting period rule discussed below but also the eventual elimination of notices of creditable coverage under HIPAA’s preexisting condition exclusions rules.
The 2010 health care reform law prohibits group health plans from imposing preexisting condition exclusions, effective for plan years beginning on or after January 1, 2014, but the law did not eliminate the requirement (under the 1996 health insurance portability law “HIPAA”) that group health plans and health insurance issuers provide HIPAA certificates of creditable coverage to plan participants. Since non-calendar year plans may continue to impose pre-existing condition limitations after January 1, 2014 and until the first day of the 2014 plan year, the proposed regulations would not eliminate the requirement to provide certificates of creditable coverage until after 2014. This is so that individuals needing to offset a pre-existing condition exclusion applicable under a non-calendar year plan would still have access to certificates for proof of coverage through December 31, 2014.
After 2014, the health care reform law’s prohibition on preexisting condition exclusions will make HIPAA’s detailed rules on the application of preexisting condition exclusions obsolete, so final regulations are expected to eliminate the requirement to provide certificates of creditable coverage. Until then, group health plans and health insurance issuers must continue to provide HIPAA certificates of creditable coverage.