Fill and Sign the Department of Labor 2004m1formemploymentwelfare

DOL Chart Of HIPAA Notice Requirements Typ e o f D is c lo su reA pp lic ab ilityC onte n t S um maryW hen P ro vid edE ach c ertif ic ate m ust in clu de: D ate i s su ed ;N am e o f p la n ;In div id ualí s n am e a n d I D ;Pla n a d m in is tr a to r na m e, a d dre ss, a n d p hone nu m ber;P hone n um ber f o r fu rth er i n fo rm atio n;In div id ualí s c re d ita b le co vera g e i n fo rm atio n; a n dE ducatio nals ta te m en t.W hen t h e c ertif ic ate i s p ro vid ed upon r e q uest, a s s o on a s p ossib le .W hen t h e c ertif ic ate i s p ro vid ed auto m atic a lly u po n l o ss o f c o vera g e an d a C O BRA qualif y in g e v en t, n ot la te r t h an t h e e n d o f t h e p erio dfo r pr o vid in g C O BRA n otic e ( g en era lly 4 4 day s).W hen t h e c ertif ic ate i s p ro vid ed auto m atic a lly u po n l o ss o f c o vera g e an d n ot a C O BRA q ualif y in g e v en t, wi t h in a r e aso nab le t im e a fte r c o vera g e ce ase s ( a s s o on a s p ossib le ).H IP A A c ertif ic a te o f cr ed it a b le c o ver a ge (ß 7 01 (e ); 2 9 C FR 2590.7 01-5 )A ll g ro up h ealth pla n s. The p la n m ust d is c lo se Must b e p ro vid ed befo re at h e e x is te n ce a n d t e rm s p re ex is tin g c o nditio n e x clu sio n o f a n y p re ex is tin g c o ndi m ay b e a p plie d t o a n y i n ditio n exclu sio n u nder t h e v id ual.p la n a n d t h e r ig h ts o f i n div id uals t o d em on str a te c re d ita b le c o vera g e. T his i n clu des a d esc rip tio n o f t h e r ig ht o f t h e in div id ual t o r e q uest a c ertif ic ate f ro m a p rio r p la n o r i s su er a n d a s ta te m en t t h at t h e c u rre n t p la n w ill a ssis t i n o bta in in g a ce rtif ic ate f ro m a n y p rio r p la n o r i s su er, i f n ecessa ry . T his n otic e m ust i n clu de: T he p la ní s d ete rm in atio n o f t h e p erio d o f c re d ita b le c o vera g e ( n ote : t h e p la n m ust a llo w t h e i n div id ual a r e aso nab le op portu nity t o s u b m it a d ditio nal e v id en ce o f c re d ita b le c o vera g e);T he r e m ain in g p re ex is tin g c o nditio n e x clu sio n p erio d t h at w ill a p p ly t o t h e i n div id ual; a n dA d esc rip tio n o f a n y a p pealp ro ced ure se sta b lis h ed b y t h e p la n o r i s su er.G en era l n otic e of p reex is tin g con dit io n exclu sio n (2 9 C FR 2 590.7 01- 3(c ))A ny g ro up h ealth pla n t h at c o nta in s a pre ex is tin g c o ndit io n ex clu sio n .In d iv id ual no tic e o f p reex is tin g con dit io n e x clu sio n (29 C FR 2 590.7 01- 5(d ))G ro up h ealth p la n s th at c o nta in a pre ex is tin g c o ndit io n ex clu sio n , b ut o n ly afte r r e ce iv in g cre d ita b le c o vera g e in fo rm atio n f ro m a n in div id ual t h at i s n ot en ough t o o ffs e t t h e pre ex is tin g c o ndit io n ex clu sio n p erio d. W ith in a r e aso nab le t im e o f t h e pre se n ta tio n o f c re d ita b le c o vera g e by t h e i n d iv id ual. Typ e o f D is c lo su reA pp lic ab ilityC on te n t S um maryW hen P ro vid edN otic e o f s p ecia len ro llm en t r ig h ts(2 9 C FR 2 590.7 01-6(c ))A ll g ro u p h ealthp la n s.A d esc rip tio n o f t h e p la ní ssp ecia le n ro llm en tr u le s.O n o r b efo re t h e t im e a nem plo yeeis o ffe re d an oppor-tu nity t o e n ro ll i n t h e p la n .