U.S. Department of Labor
Health Benefits Advisor for Employers
Determining Compliance with the HIPAA Provisions in Part 7 of ERISA
Limits on Preexisting Condition Exclusions - Determination of Creditable Coverage
Does the plan comply with the requirements relating to determination of individuals' creditable coverage?
If a plan receives creditable coverage information from an individual, the plan is required to make a determination regarding the amount of the individual's creditable coverage and the length of any preexisting condition exclusion that remains. This determination must be made within a reasonable time following the receipt of the creditable coverage information. Whether this determination is made within a reasonable time depends on all the relevant facts and circumstances, including whether the plan's application of a preexisting condition exclusion would prevent an individual from having access to urgent medical care. See 29 CFR 2590.701-3(d)(1).
A plan may not impose any limit on the amount of time an individual has to present a certificate or other evidence of creditable coverage. See 29 CFR 2590.701-3(d)(2).
