[Code of Federal Regulations]
[Title 29, Volume 9]
[Revised as of July 1, 2004]
From the U.S. Government Printing Office via GPO Access
[CITE: 29CFR2590.701-5]

[Page 635-643]
 
                             TITLE 29--LABOR
 
 CHAPTER XXV--EMPLOYEE BENEFITS SECURITY ADMINISTRATION, DEPARTMENT OF 
                                  LABOR
 
PART 2590_RULES AND REGULATIONS FOR GROUP HEALTH PLANS--Table of Contents
 
Subpart B_Requirements Relating to Access and Renewability of Coverage, 
       and Limitations on Preexisting Condition Exclusion Periods
 
Sec. 2590.701-5  Certification and disclosure of previous coverage.

    (a) Certificate of creditable coverage--(1) Entities required to 
provide certificate--(i) In general. A group health plan, and each 
health insurance issuer offering group health insurance coverage under a 
group health plan, is required to furnish certificates of creditable 
coverage in accordance with this paragraph (a).
    (ii) Duplicate certificates not required. An entity required to 
provide a certificate under this paragraph (a)(1) for an individual is 
deemed to have satisfied the certification requirements for that 
individual if another party provides the certificate, but only to the 
extent that information relating to the individual's creditable coverage 
and waiting or affiliation period is provided by the other party. For 
example, in the case of a group health plan funded through an insurance 
policy, the issuer is deemed to have satisfied the certification 
requirement with respect to a participant or beneficiary if the plan 
actually provides a certificate that includes the information required 
under paragraph (a)(3) of this section with respect to the participant 
or beneficiary.
    (iii) Special rule for group health plans. To the extent coverage 
under a plan consists of group health insurance coverage, the plan is 
deemed to have satisfied the certification requirements under this 
paragraph (a)(1) if any issuer offering the coverage is required to 
provide the certificates pursuant to an agreement between the plan and 
the issuer. For example, if there is an agreement between an issuer and 
the plan sponsor under which the issuer agrees to provide certificates 
for individuals covered under the plan, and the issuer fails to provide 
a certificate to an individual when the plan would have been required to 
provide one under this paragraph (a), then the issuer, but not the plan, 
violates the certification requirements of this paragraph (a).
    (iv) Special rules for issuers--(A)(1) Responsibility of issuer for 
coverage period. An issuer is not required to provide information 
regarding coverage provided to an individual by another party.
    (2) Example. The rule of this paragraph (a)(1)(iv)(A) is illustrated 
by the following example:

    Example. (i) A plan offers coverage with an HMO option from one 
issuer and an indemnity option from a different issuer. The HMO has not 
entered into an agreement with the

[[Page 636]]

plan to provide certificates as permitted under paragraph (a)(1)(iii) of 
this section.
    (ii) In this Example, if an employee switches from the indemnity 
option to the HMO option and later ceases to be covered under the plan, 
any certificate provided by the HMO is not required to provide 
information regarding the employee's coverage under the indemnity 
option.

    (B)(1) Cessation of issuer coverage prior to cessation of coverage 
under a plan. If an individual's coverage under an issuer's policy 
ceases before the individual's coverage under the plan ceases, the 
issuer is required to provide sufficient information to the plan (or to 
another party designated by the plan) to enable a certificate to be 
provided by the plan (or other party), after cessation of the 
individual's coverage under the plan, that reflects the period of 
coverage under the policy. The provision of that information to the plan 
will satisfy the issuer's obligation to provide an automatic certificate 
for that period of creditable coverage for the individual under 
paragraph (a) (2)(ii) and (3) of this section. In addition, an issuer 
providing that information is required to cooperate with the plan in 
responding to any request made under paragraph (b)(1) of this section 
(relating to the alternative method of counting creditable coverage). If 
the individual's coverage under the plan ceases at the time the 
individual's coverage under the issuer's policy ceases, the issuer must 
provide an automatic certificate under paragraph (a)(2)(ii) of this 
section. An issuer may presume that an individual whose coverage ceases 
at a time other than the effective date for changing enrollment options 
has ceased to be covered under the plan.
    (2) Example. The rule of this paragraph (a)(1)(iv)(B) is illustrated 
by the following example.

    Example. (i) A group health plan provides coverage under an HMO 
option and an indemnity option with a different issuer, and only allows 
employees to switch on each January 1. Neither the HMO nor the indemnity 
issuer has entered into an agreement with the plan to provide 
certificates as permitted under paragraph (a)(1)(iii) of this section.
    (ii) In this Example, if an employee switches from the indemnity 
option to the HMO option on January 1, the issuer must provide the plan 
(or a person designated by the plan) with appropriate information with 
respect to the individual's coverage with the indemnity issuer. However, 
if the individual's coverage with the indemnity issuer ceases at a date 
other than January 1, the issuer is instead required to provide the 
individual with an automatic certificate.

    (2) Individuals for whom certificate must be provided; timing of 
issuance--(i) Individuals. A certificate must be provided, without 
charge, for participants or dependents who are or were covered under a 
group health plan upon the occurrence of any of the events described in 
paragraph (a)(2)(ii) or (iii) of this section.
    (ii) Issuance of automatic certificates. The certificates described 
in this paragraph (a)(2)(ii) are referred to as automatic certificates.
    (A) Qualified beneficiaries upon a qualifying event. In the case of 
an individual who is a qualified beneficiary (as defined in section 
607(3) of the Act) entitled to elect COBRA continuation coverage, an 
automatic certificate is required to be provided at the time the 
individual would lose coverage under the plan in the absence of COBRA 
continuation coverage or alternative coverage elected instead of COBRA 
continuation coverage. A plan or issuer satisfies this requirement if it 
provides the automatic certificate no later than the time a notice is 
required to be furnished for a qualifying event under section 606 of the 
Act (relating to notices required under COBRA).
    (B) Other individuals when coverage ceases. In the case of an 
individual who is not a qualified beneficiary entitled to elect COBRA 
continuation coverage, an automatic certificate is required to be 
provided at the time the individual ceases to be covered under the plan. 
A plan or issuer satisfies this requirement if it provides the automatic 
certificate within a reasonable time period thereafter. In the case of 
an individual who is entitled to elect to continue coverage under a 
State program similar to COBRA and who receives the automatic 
certificate not later than the time a notice is required to be furnished 
under the State program, the certificate is deemed to be provided within 
a reasonable time period after the cessation of coverage under the plan.

[[Page 637]]

    (C) Qualified beneficiaries when COBRA ceases. In the case of an 
individual who is a qualified beneficiary and has elected COBRA 
continuation coverage (or whose coverage has continued after the 
individual became entitled to elect COBRA continuation coverage), an 
automatic certificate is to be provided at the time the individual's 
coverage under the plan ceases. A plan, or issuer, satisfies this 
requirement if it provides the automatic certificate within a reasonable 
time after coverage ceases (or after the expiration of any grace period 
for nonpayment of premiums). An automatic certificate is required to be 
provided to such an individual regardless of whether the individual has 
previously received an automatic certificate under paragraph 
(a)(2)(ii)(A) of this section.
    (iii) Any individual upon request. Requests for certificates are 
permitted to be made by, or on behalf of, an individual within 24 months 
after coverage ceases. Thus, for example, a plan in which an individual 
enrolls may, if authorized by the individual, request a certificate of 
the individual's creditable coverage on behalf of the individual from a 
plan in which the individual was formerly enrolled. After the request is 
received, a plan or issuer is required to provide the certificate by the 
earliest date that the plan or issuer, acting in a reasonable and prompt 
fashion, can provide the certificate. A certificate is required to be 
provided under this paragraph (a)(2)(iii) even if the individual has 
previously received a certificate under this paragraph (a)(2)(iii) or an 
automatic certificate under paragraph (a)(2)(ii) of this section.
    (iv) Examples. The following examples illustrate the rules of this 
paragraph (a)(2):

    Example 1. (i) Individual A terminates employment with Employer Q. A 
is a qualified beneficiary entitled to elect COBRA continuation coverage 
under Employer Q's group health plan. A notice of the rights provided 
under COBRA is typically furnished to qualified beneficiaries under the 
plan within 10 days after a covered employee terminates employment.
    (ii) In this Example 1, the automatic certificate may be provided at 
the same time that A is provided the COBRA notice.
    Example 2. (i) Same facts as Example 1, except that the automatic 
certificate for A is not completed by the time the COBRA notice is 
furnished to A.
    (ii) In this Example 2, the automatic certificate may be provided 
within the period permitted by law for the delivery of notices under 
COBRA.
    Example 3. (i) Employer R maintains an insured group health plan. R 
has never had 20 employees and thus R's plan is not subject to the COBRA 
continuation coverage provisions. However, R is in a State that has a 
State program similar to COBRA. B terminates employment with R and loses 
coverage under R's plan.
    (ii) In this Example 3, the automatic certificate may be provided 
not later than the time a notice is required to be furnished under the 
State program.
    Example 4. (i) Individual C terminates employment with Employer S 
and receives both a notice of C's rights under COBRA and an automatic 
certificate. C elects COBRA continuation coverage under Employer S's 
group health plan. After four months of COBRA continuation coverage and 
the expiration of a 30-day grace period, Employer S's group health plan 
determines that C's COBRA continuation coverage has ceased due to 
failure to make a timely payment for continuation coverage.
    (ii) In this Example 4, the plan must provide an updated automatic 
certificate to C within a reasonable time after the end of the grace 
period.
    Example 5. (i) Individual D is currently covered under the group 
health plan of Employer T. D requests a certificate, as permitted under 
paragraph (a)(2)(iii) of this section. Under the procedure for Employer 
T's plan, certificates are mailed (by first class mail) 7 business days 
following receipt of the request. This date reflects the earliest date 
that the plan, acting in a reasonable and prompt fashion, can provide 
certificates.
    (ii) In this Example 5, the plan's procedure satisfies paragraph 
(a)(2)(iii) of this section.

    (3) Form and content of certificate-- (i) Written certificate--(A) 
In general. Except as provided in paragraph (a)(3)(i)(B) of this 
section, the certificate must be provided in writing (including any form 
approved by the Secretary as a writing).
    (B) Other permissible forms. No written certificate is required to 
be provided under this paragraph (a) with respect to a particular event 
described in paragraph (a)(2) (ii) or (iii) of this section, if--
    (1) An individual is entitled to receive a certificate;

[[Page 638]]

    (2) The individual requests that the certificate be sent to another 
plan or issuer instead of to the individual;
    (3) The plan or issuer that would otherwise receive the certificate 
agrees to accept the information in this paragraph (a)(3) through means 
other than a written certificate (e.g., by telephone); and
    (4) The receiving plan or issuer receives such information from the 
sending plan or issuer in such form within the time periods required 
under paragraph (a)(2) of this section.
    (ii) Required information. The certificate must include the 
following--
    (A) The date the certificate is issued;
    (B) The name of the group health plan that provided the coverage 
described in the certificate;
    (C) The name of the participant or dependent with respect to whom 
the certificate applies, and any other information necessary for the 
plan providing the coverage specified in the certificate to identify the 
individual, such as the individual's identification number under the 
plan and the name of the participant if the certificate is for (or 
includes) a dependent;
    (D) The name, address, and telephone number of the plan 
administrator or issuer required to provide the certificate;
    (E) The telephone number to call for further information regarding 
the certificate (if different from paragraph (a)(3)(ii)(D) of this 
section);
    (F) Either--
    (1) A statement that an individual has at least 18 months (for this 
purpose, 546 days is deemed to be 18 months) of creditable coverage, 
disregarding days of creditable coverage before a significant break in 
coverage, or
    (2) The date any waiting period (and affiliation period, if 
applicable) began and the date creditable coverage began; and
    (G) The date creditable coverage ended, unless the certificate 
indicates that creditable coverage is continuing as of the date of the 
certificate.
    (iii) Periods of coverage under certificate. If an automatic 
certificate is provided pursuant to paragraph (a)(2)(ii) of this 
section, the period that must be included on the certificate is the last 
period of continuous coverage ending on the date coverage ceased. If an 
individual requests a certificate pursuant to paragraph (a)(2)(iii) of 
this section, a certificate must be provided for each period of 
continuous coverage ending within the 24-month period ending on the date 
of the request (or continuing on the date of the request). A separate 
certificate may be provided for each such period of continuous coverage.
    (iv) Combining information for families. A certificate may provide 
information with respect to both a participant and the participant's 
dependents if the information is identical for each individual or, if 
the information is not identical, certificates may be provided on one 
form if the form provides all the required information for each 
individual and separately states the information that is not identical.
    (v) Model certificate. The requirements of paragraph (a)(3)(ii) of 
this section are satisfied if the plan or issuer provides a certificate 
in accordance with a model certificate authorized by the Secretary.
    (vi) Excepted benefits; categories of benefits. No certificate is 
required to be furnished with respect to excepted benefits described in 
Sec. 2590.732. In addition, the information in the certificate 
regarding coverage is not required to specify categories of benefits 
described in Sec. 2590.701-4(c) (relating to the alternative method of 
counting creditable coverage). However, if excepted benefits are 
provided concurrently with other creditable coverage (so that the 
coverage does not consist solely of excepted benefits), information 
concerning the benefits may be required to be disclosed under paragraph 
(b) of this section.
    (4) Procedures--(i) Method of delivery. The certificate is required 
to be provided to each individual described in paragraph (a)(2) of this 
section or an entity requesting the certificate on behalf of the 
individual. The certificate may be provided by first-class mail. If the 
certificate or certificates are provided to the participant and the 
participant's spouse at the participant's last known address, then the 
requirements of this paragraph (a)(4) are satisfied with respect to all 
individuals residing at that address. If a dependent's

[[Page 639]]

last known address is different than the participant's last known 
address, a separate certificate is required to be provided to the 
dependent at the dependent's last known address. If separate 
certificates are being provided by mail to individuals who reside at the 
same address, separate mailings of each certificate are not required.
    (ii) Procedure for requesting certificates. A plan or issuer must 
establish a procedure for individuals to request and receive 
certificates pursuant to paragraph (a)(2)(iii) of this section.
    (iii) Designated recipients. If an automatic certificate is required 
to be provided under paragraph (a)(2)(ii) of this section, and the 
individual entitled to receive the certificate designates another 
individual or entity to receive the certificate, the plan or issuer 
responsible for providing the certificate is permitted to provide the 
certificate to the designated party. If a certificate is required to be 
provided upon request under paragraph (a)(2)(iii) of this section and 
the individual entitled to receive the certificate designates another 
individual or entity to receive the certificate, the plan or issuer 
responsible for providing the certificate is required to provide the 
certificate to the designated party.
    (5) Special rules concerning dependent coverage--(i)(A) Reasonable 
efforts. A plan or issuer is required to use reasonable efforts to 
determine any information needed for a certificate relating to dependent 
coverage. In any case in which an automatic certificate is required to 
be furnished with respect to a dependent under paragraph (a)(2)(ii) of 
this section, no individual certificate is required to be furnished 
until the plan or issuer knows (or making reasonable efforts should 
know) of the dependent's cessation of coverage under the plan.
    (B) Example. The rules of this paragraph (a)(5) are illustrated by 
the following example:

    Example. (i) A group health plan covers employees and their 
dependents. The plan annually requests all employees to provide updated 
information regarding dependents, including the specific date on which 
an employee has a new dependent or on which a person ceases to be a 
dependent of the employee.
    (ii) In this Example, the plan has satisfied the standard in this 
paragraph (a)(5)(i) that it make reasonable efforts to determine the 
cessation of dependents' coverage and the related dependent coverage 
information.

    (ii) Special rules for demonstrating coverage. If a certificate 
furnished by a plan or issuer does not provide the name of any dependent 
of an individual covered by the certificate, the individual may, if 
necessary, use the procedures described in paragraph (c)(4) of this 
section for demonstrating dependent status. In addition, an individual 
may, if necessary, use these procedures to demonstrate that a child was 
enrolled within 30 days of birth, adoption, or placement for adoption. 
See Sec. 2590.701-3(b), under which such a child would not be subject 
to a preexisting condition exclusion.
    (iii) Transition rule for dependent coverage through June 30, 1998--
(A) In general. A group health plan or health insurance issuer that 
cannot provide the names of dependents (or related coverage information) 
for purposes of providing a certificate of coverage for a dependent may 
satisfy the requirements of paragraph (a)(3)(ii)(C) of this section by 
providing the name of the participant covered by the group health plan 
or health insurance issuer and specifying that the type of coverage 
described in the certificate is for dependent coverage (e.g., family 
coverage or employee-plus-spouse coverage).
    (B) Certificates provided on request. For purposes of certificates 
provided on the request of, or on behalf of, an individual pursuant to 
paragraph (a)(2)(iii) of this section, a plan or issuer must make 
reasonable efforts to obtain and provide the names of any dependent 
covered by the certificate where such information is requested to be 
provided. If a certificate does not include the name of any dependent of 
an individual covered by the certificate, the individual may, if 
necessary, use the procedures described in paragraph (c) of this section 
for submitting documentation to establish that the creditable coverage 
in the certificate applies to the dependent.
    (C) Demonstrating a dependent's creditable coverage. See paragraph 
(c)(4) of this section for special rules to demonstrate dependent 
status.

[[Page 640]]

    (D) Duration. This paragraph (a)(5)(iii) is only effective for 
certificates provided with respect to events occurring through June 30, 
1998.
    (6) Special certification rules for entities not subject to part 7 
of subtitle B of title I of the Act--(i) Issuers. For special rules 
requiring that issuers, not subject to part 7 of subtitle B of title I 
of the Act, provide certificates consistent with the rules in this 
section, including issuers offering coverage with respect to creditable 
coverage described in sections 701(c)(1)(G) through (c)(1)(J) of the Act 
(coverage under a State health benefits risk pool, the Federal Employees 
Health Benefits Program, a public health plan, and a health benefit plan 
under section 5(e) of the Peace Corps Act), see section 2721(b)(1)(B) of 
the PHSA (requiring certificates by issuers offering health insurance 
coverage in connection with a group health plan, including a church plan 
or a governmental plan (including the Federal Employees Health Benefits 
Program (FEHBP)). In addition, see section 2743 of the PHSA applicable 
to health insurance issuers in the individual market. (However, this 
section does not require a certificate to be provided with respect to 
short-term limited duration insurance, as described in the definition of 
individual health insurance coverage in Sec. 2590.701-2, that is not 
provided by a group health plan or issuer offering health insurance in 
connection with a group health plan.)
    (ii) Other entities. For special rules requiring that certain other 
entities, not subject to part 7 of subtitle B of title I of the Act, 
provide certificates consistent with the rules in this section, see 
section 2791(a)(3) of the PHSA applicable to entities described in 
sections 2701(c)(1)(C), (D), (E), and (F) of PHSA (relating to Medicare, 
Medicaid, CHAMPUS, and Indian Health Service), section 2721(b)(1)(A) of 
the PHSA applicable to nonfederal governmental plans generally, section 
2721(b)(2)(C)(ii) of the PHSA applicable to nonfederal governmental 
plans that elect to be excluded from the requirements of subparts 1 
through 3 of part A of title XXVII of the PHSA, and section 9805(a) of 
the Internal Revenue Code applicable to group health plans, which 
includes church plans (as defined in section 414(e) of the Internal 
Revenue Code).
    (b) Disclosure of coverage to a plan, or issuer, using the 
alternative method of counting creditable coverage--(1) In general. If 
an individual enrolls in a group health plan with respect to which the 
plan, or issuer, uses the alternative method of counting creditable 
coverage described in Sec. 2590.701-4(c) the individual provides a 
certificate of coverage under paragraph (a) of this section, and the 
plan or issuer in which the individual enrolls so requests, the entity 
that issued the certificate (the prior entity) is required to disclose 
promptly to a requesting plan or issuer (the requesting entity) the 
information set forth in paragraph (b)(2) of this section.
    (2) Information to be disclosed. The prior entity is required to 
identify to the requesting entity the categories of benefits with 
respect to which the requesting entity is using the alternative method 
of counting creditable coverage, and the requesting entity may identify 
specific information that the requesting entity reasonably needs in 
order to determine the individual's creditable coverage with respect to 
any such category. The prior entity is required to disclose promptly to 
the requesting entity the creditable coverage information so requested.
    (3) Charge for providing information. The prior entity furnishing 
the information under paragraph (b) of this section may charge the 
requesting entity for the reasonable cost of disclosing such 
information.
    (c) Ability of an individual to demonstrate creditable coverage and 
waiting period information--(1) In general. The rules in this paragraph 
(c) implement section 701(c)(4) of the Act, which permits individuals to 
establish creditable coverage through means other than certificates, and 
section 701(e)(3) of the Act, which requires the Secretary to establish 
rules designed to prevent an individual's subsequent coverage under a 
group health plan or health insurance coverage from being adversely 
affected by an entity's failure to provide a certificate with respect to 
that individual. If the accuracy of a certificate is contested or a 
certificate is unavailable

[[Page 641]]

when needed by the individual, the individual has the right to 
demonstrate creditable coverage (and waiting or affiliation periods) 
through the presentation of documents or other means. For example, the 
individual may make such a demonstration when--
    (i) An entity has failed to provide a certificate within the 
required time period;
    (ii) The individual has creditable coverage but an entity may not be 
required to provide a certificate of the coverage pursuant to paragraph 
(a) of this section;
    (iii) The coverage is for a period before July 1, 1996;
    (iv) The individual has an urgent medical condition that 
necessitates a determination before the individual can deliver a 
certificate to the plan; or
    (v) The individual lost a certificate that the individual had 
previously received and is unable to obtain another certificate.
    (2) Evidence of creditable coverage--(i) Consideration of evidence. 
A plan or issuer is required to take into account all information that 
it obtains or that is presented on behalf of an individual to make a 
determination, based on the relevant facts and circumstances, whether an 
individual has creditable coverage and is entitled to offset all or a 
portion of any preexisting condition exclusion period. A plan or issuer 
shall treat the individual as having furnished a certificate under 
paragraph (a) of this section if the individual attests to the period of 
creditable coverage, the individual also presents relevant corroborating 
evidence of some creditable coverage during the period, and the 
individual cooperates with the plan's or issuer's efforts to verify the 
individual's coverage. For this purpose, cooperation includes providing 
(upon the plan's or issuer's request) a written authorization for the 
plan or issuer to request a certificate on behalf of the individual, and 
cooperating in efforts to determine the validity of the corroborating 
evidence and the dates of creditable coverage. While a plan or issuer 
may refuse to credit coverage where the individual fails to cooperate 
with the plan's or issuer's efforts to verify coverage, the plan or 
issuer may not consider an individual's inability to obtain a 
certificate to be evidence of the absence of creditable coverage.
    (ii) Documents. Documents that may establish creditable coverage 
(and waiting periods or affiliation periods) in the absence of a 
certificate include explanations of benefit claims (EOBs) or other 
correspondence from a plan or issuer indicating coverage, pay stubs 
showing a payroll deduction for health coverage, a health insurance 
identification card, a certificate of coverage under a group health 
policy, records from medical care providers indicating health coverage, 
third party statements verifying periods of coverage, and any other 
relevant documents that evidence periods of health coverage.
    (iii) Other evidence. Creditable coverage (and waiting period or 
affiliation period information) may also be established through means 
other than documentation, such as by a telephone call from the plan or 
provider to a third party verifying creditable coverage.
    (iv) Example. The rules of this paragraph (c)(2) are illustrated by 
the following example:

    Example. (i) Individual F terminates employment with Employer W and, 
a month later, is hired by Employer X. Employer X's group health plan 
imposes a preexisting condition exclusion of 12 months on new enrollees 
under the plan and uses the standard method of determining creditable 
coverage. F fails to receive a certificate of prior coverage from the 
self-insured group health plan maintained by F's prior employer, 
Employer W, and requests a certificate. However, F (and Employer X's 
plan, on F's behalf) is unable to obtain a certificate from Employer W's 
plan. F attests that, to the best of F's knowledge, F had at least 12 
months of continuous coverage under Employer W's plan, and that the 
coverage ended no earlier than F's termination of employment from 
Employer W. In addition, F presents evidence of coverage, such as an 
explanation of benefits for a claim that was made during the relevant 
period.
    (ii) In this Example, based solely on these facts, F has 
demonstrated creditable coverage for the 12 months of coverage under 
Employer W's plan in the same manner as if F had presented a written 
certificate of creditable coverage.

    (3) Demonstrating categories of creditable coverage. Procedures 
similar to those described in this paragraph (c) apply in order to 
determine an individual's creditable coverage with respect

[[Page 642]]

to any category under paragraph (b) of this section (relating to 
determining creditable coverage under the alternative method).
    (4) Demonstrating dependent status. If, in the course of providing 
evidence (including a certificate) of creditable coverage, an individual 
is required to demonstrate dependent status, the group health plan or 
issuer is required to treat the individual as having furnished a 
certificate showing the dependent status if the individual attests to 
such dependency and the period of such status and the individual 
cooperates with the plan's or issuer's efforts to verify the dependent 
status.
    (d) Determination and notification of creditable coverage--(1) 
Reasonable time period. In the event that a group health plan or health 
insurance issuer offering group health insurance coverage receives 
information under paragraph (a) of this section (certifications), 
paragraph (b) of this section (disclosure of information relating to the 
alternative method), or paragraph (c) of this section (other evidence of 
creditable coverage), the entity is required, within a reasonable time 
period following receipt of the information, to make a determination 
regarding the individual's period of creditable coverage and notify the 
individual of the determination in accordance with paragraph (d)(2) of 
this section. Whether a determination and notification regarding an 
individual's creditable coverage is made within a reasonable time period 
is determined based on the relevant facts and circumstances. Relevant 
facts and circumstances include whether a plan's application of a 
preexisting condition exclusion would prevent an individual from having 
access to urgent medical services.
    (2) Notification to individual of period of preexisting condition 
exclusion. A plan or issuer seeking to impose a preexisting condition 
exclusion is required to disclose to the individual, in writing, its 
determination of any preexisting condition exclusion period that applies 
to the individual, and the basis for such determination, including the 
source and substance of any information on which the plan or issuer 
relied. In addition, the plan or issuer is required to provide the 
individual with a written explanation of any appeal procedures 
established by the plan or issuer, and with a reasonable opportunity to 
submit additional evidence of creditable coverage. However, nothing in 
this paragraph (d) or paragraph (c) of this section prevents a plan or 
issuer from modifying an initial determination of creditable coverage if 
it determines that the individual did not have the claimed creditable 
coverage, provided that--
    (i) A notice of such reconsideration, as described in this paragraph 
(d), is provided to the individual; and
    (ii) Until the final determination is made, the plan or issuer, for 
purposes of approving access to medical services (such as a pre-surgery 
authorization), acts in a manner consistent with the initial 
determination.
    (3) Examples. The following examples illustrate this paragraph (d):

    Example 1. (i) Individual G is hired by Employer Y. Employer Y's 
group health plan imposes a preexisting condition exclusion for 12 
months with respect to new enrollees and uses the standard method of 
determining creditable coverage. Employer Y's plan determines that G is 
subject to a 4-month preexisting condition exclusion, based on a 
certificate of creditable coverage that is provided by G to Employer Y's 
plan indicating 8 months of coverage under G's prior group health plan.
    (ii) In this Example 1, Employer Y's plan must notify G within a 
reasonable period of time following receipt of the certificate that G is 
subject to a 4-month preexisting condition exclusion beginning on G's 
enrollment date in Y's plan.
    Example 2. (i) Same facts as in Example 1, except that Employer Y's 
plan determines that G has 14 months of creditable coverage based on G's 
certificate indicating 14 months of creditable coverage under G's prior 
plan.
    (ii) In this Example 2, Employer Y's plan is not required to notify 
G that G will not be subject to a preexisting condition exclusion.
    Example 3. (i) Individual H is hired by Employer Z. Employer Z's 
group health plan imposes a preexisting condition exclusion for 12 
months with respect to new enrollees and uses the standard method of 
determining creditable coverage. H develops an urgent health condition 
before receiving a certificate of prior coverage. H attests to the 
period of prior coverage, presents corroborating documentation of the 
coverage period, and authorizes the plan to request a certificate on H's 
behalf.
    (ii) In this Example 3, Employer Z's plan must review the evidence 
presented by H. In

[[Page 643]]

addition, the plan must make a determination and notify H regarding any 
preexisting condition exclusion period that applies to H (and the basis 
of such determination) within a reasonable time period following receipt 
of the evidence that is consistent with the urgency of H's health 
condition (this determination may be modified as permitted under 
paragraph (d)(2) of this section).

(Approved by the Office of Management and Budget under control numbers 
1210-0102 and 1210-0103)

[62 FR 16941, Apr. 8, 1997; 62 FR 31670, 31692, June 10, 1997, as 
amended at 62 FR 35905, July 2, 1997. Redesignated at 65 FR 82142, Dec. 
27, 2000]