A certificate of coverage health insurance document serves as official proof of prior insurance. When you’re switching providers or starting a new Texas health insurance plan, this document shows you’ve already met certain requirements, especially when it comes to pre-existing condition waiting periods.
The certificate lists the names of insured individuals, their dates of birth, and the effective and termination dates of the previous plan. It’s a valuable document when you need to apply for health insurance again, particularly if you’re looking to avoid delays or penalties due to a gap in health insurance.
How It Affects PreExisting Condition Clauses
In some cases, new policies include a pre-existing condition clause, which may delay coverage for pre-existing conditions for up to 12 months on certain plans. However, this waiting period can be waived if you meet the continuous coverage requirement. If applying for a Marketplace plan outside of open enrollment, this document will prove your “Special Enrollment Provision” and allow you to obtain coverage.
Here’s how it works:
- You must show at least 12 months of continuous coverage with no more than a 63-day gap in health insurance.
- Your certificate of coverage must be submitted to your new insurer to activate the waiver.
- If applying for Marketplace coverage outside of open enrollment, this document must be submitted to the Health Insurance Marketplace before your policy will be activated.
- This rule applies to mostly to individual health insurance plans in Texas.
By providing proper documentation, you’re protecting yourself from unnecessary out-of-pocket costs and coverage delays.
How to Get a Certificate of Coverage
Getting your certificate of coverage is usually straightforward:
- Contact the customer service line of your former health insurance provider.
- Request the certificate by fax or mail.
- Once received, forward it to your new insurance broker or directly to the new insurance carrier
At Selected Benefits, we assist clients in collecting and submitting their certificates to ensure a smooth transition. Whether you’re enrolling in group coverage for small businesses or individual coverage, we help coordinate the details between your previous and new insurance providers.
Understanding Exclusion Waivers in Texas
While a certificate helps with pre-existing clauses, it doesn’t always override all health insurance exclusions. Some non-ACA compliant carriers still use exclusion waivers, which limits or delays coverage for specific conditions regardless of prior coverage.
Here’s what you need to know:
- The certificate waives the pre-existing condition clause but not necessarily the exclusion waiver.
- An exclusion waiver may apply if a carrier decides to deny coverage for certain conditions temporarily.
- To avoid this, it’s important to work with a broker who knows which carriers to avoid.
Other carriers may apply them depending on your history. Always review individual coverage requirements before enrolling.
Understand Your Options Before You Apply
Understanding how a certificate of coverage works can save you time, money, and frustration. Whether you’re enrolling in an individual plan or managing a small business health insurance strategy for your team, being aware of health insurance exclusions, waiting periods, and waiver rules is crucial.
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