NY Office - 516-352-7000

NJ Office - 973-257-5558


November 5, 2014 V ol. 22 No. 1008

Applies to: All small, mid-size and large groups

Certificates of Creditable Coverage Discontinuance
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) had required that when individuals switched health insurance plans they would be required to have a Certificate of Creditable Coverage (COCC) to bypass the pre-existing condition exclusions (the exclusion of benefits for a specific condition you had before your enrollment date in a new plan). COCCs provided a record of coverage timeframes for terminated members to receive credit for pre-existing waiting periods. In 2014, under the Affordable Care Act (ACA), individuals could no longer be denied coverage from an insurer based on a pre-existing condition, health status or claims history, thus eliminating the need
for COCCs.

Effective December 31, 2014, Horizon Blue Cross Blue Shield of New Jersey, along with all other health insurance companies, is no longer required to produce a COCC for group, subscriber and member-level terminations. Since pre-existing waiting periods are no longer allowed under a provision of the ACA, Horizon BCBSNJ will not produce the COCC systemically.

Beginning January 1, 2015, Horizon BCBSNJ will manually fulfill requests for a COCC. However, we expect that the requests will be infrequent because pre-existing waiting periods are no longer required for the majority of heath plans. Dental coverage was previously excluded from this process and although MediGap and Medicare Advantage members need to receive them for underwriting new coverage, any COCC requests for these
markets will be addressed manually upon request.

If you have questions, please contact your FNA Represntative or Horizon BCBSNJ sales executive or account manager.

PDF-icon2SMClick here to download the full pdf document