New Mexico Certificate of Group Health Plan Coverage with Statement of HIPAA Portability Rights

State:
Multi-State
Control #:
US-AHI-010
Format:
Word
Instant download

Description

This AHI form is a certificate of group health plan coverage. This form is evidence that the employee is covered under the group health care plan.
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FAQ

The definition of ?group health plan? is adopted from the statutory definition at section 1171(5)(A), and excludes from the rule as ?health plans? only the few insured or self-insured ERISA plans that have less than 50 participants and are self administered.

Individuals should retain this document for their records. CMS does not request or require a copy of this creditable coverage documentation. Therefore, individuals should not be instructed to send the certificate to CMS.

Health plans: Medicare, Medicaid, Medicare+Choice, and Medicare supplement insurers. Long-term care insurers (excluding nursing home fixed-indemnity policies) Employer-sponsored group health plans. Government- and church-sponsored health plans.

The HIPAA certificate, also known as certificate of creditable coverage, documents the health coverage you had before you lost coverage. If you had less than 18 months of continuous coverage, the certificate includes the dates any waiting period began and when coverage began and ended.

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New Mexico Certificate of Group Health Plan Coverage with Statement of HIPAA Portability Rights