When a individual no longer has health coverage under an insurance plan or policy, the Health Insurance Portability and Accountability Act (HIPAA) requires the insurance provider to issue a written statement saying that the individual had health coverage.
Many health insurance policies limit coverage for a medical condition that a individual had before he or she was eligible for health insurance. Limiting coverage for this reason is called using a “pre-existing condition exclusion.” The purpose of the written statement is to limit the use of the pre-existing condition exclusion. Anyone who had health insurance within two years before applying for new health insurance must get coverage for pre-existing conditions. The Centers for Medicare and Medicaid Services (CMS) requires states to issue written statements for MA recipients when someone asks for one.
A individual can ask the CAO for a Certificate of Health Coverage (PA 1824) by contacting or completing a Request for Certificate of Health Coverage (PA 1823). The CAO will complete a PA 1824, using information in CIS, and send it to the individual. All household members and their dates of coverage should be included on the form.
Updated February 14, 2012, Replacing April 12, 2007