HIPAA and Creditable Coverage Research Papers
One of the major HIPAA Provisions has to do with pre-existing conditions and “creditable coverage.” A pre-existing condition is rigidly defined by HIPAA. The Center For Medicare and Medicaid Services internet pamphlet, “Employer Questions and Answers About HIPAA,” (2002) has noted that a pre-existing condition is, under the Act, any physical or mental condition for which, a person received medical advice and/or diagnosis and/or care and/or a recommendation for treatment and/or treatment itself within 6 months before enrolling in a plan or a policy. A group health plan can exclude treatment, i.e. refuse to pay for it, for such a condition for 12 months after enrollment or 18 months for a late enrollee. However, this period of exclusion is reduced by an individual’s prior “creditable coverage.”
Creditable coverage includes most types of health coverage including group and individual insurance, and a variety of government sponsored forms of coverage such as Medicare and Medicaid. Periods of prior creditable coverage count against the exclusionary period if there has been no break in the coverage of 63 days or more. If there has been such a break, then only the period of credible coverage after the break counts as an offset against the exclusion period.
A newly hired employee usually notifies the new employer and/or the employer’s insurance carrier by means of a certificate which he/she obtains either from the previous employer or that employer’s insurance carrier. If a company’s medical insurance plan does make use of the pre-existing condition exclusionary period, then the employer has the burden of obtaining the new hire’s certificate and passing it on to the carrier. There are therefore some circumstances in which companies—rather than carriers--are required to issue and to receive this documentation and this task would logically fall within the purview of the Human Resources Department.
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A research paper is an in-depth examination of HIPAA and Creditable Coverage. More than just an overview of what was learned on HIPAA and Creditable Coverage, like a term paper is, a research paper contains analysis of HIPAA and Creditable Coverage along the lines of organizational theory and relevant published material. Research papers are highly analytical and can often be more than 8 to 10 pages. The key to a good research project is the examination of recently published journal articles and peer-reviewed material on the HIPAA and Creditable Coverage chosen. Like the name implies, research papers are exactly that, a paper that examines the information that can be found on HIPAA and Creditable Coverage.
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