Procedure to Request Creditable Coverage Letter

A federal law called HIPAA requires that the Fund provide a Certificate of Creditable Coverage (HIPAA Certificate) to each individual who requests one so long as it is requested while the individual is covered under the Plan or within 24 months after the individual’s coverage under the Plan ends. The request can also be made by someone else on behalf of an individual. For example, an individual who previously was covered under this Plan may authorize a new plan in which the individual enrolls to request a certificate of the individual’s creditable coverage from the Plan. An individual is entitled to receive a Certificate upon request even if the Plan has previously issued a Certificate to that individual.

Requests for Certificates should be directed to the Fund Office of the Teamsters Joint Council No. 83 of Virginia Health and Welfare Fund, 8814 Fargo Road, Suite 200, Richmond, VA 23229, 1-804-282-3131.  Telephone requests are accepted only if the Certificate is to be mailed to the address that the Plan has on file for the individual for whom the request relates.  Other requests must be made in writing.

All requests must include:

        The name of the individual for whom the Certificate is requested;

        The last date that the individual was covered under the Plan;

        The name of the participant that enrolled the individual in the Plan; and

        A telephone number to reach the individual for whom the Certificate is requested, in the event of  any difficulties.

Requests that are required to be made in writing must also include:

The name of the person making the request and evident of that person’s authority to request and receive the Certificate on behalf of the individual;

The address to which the Certificate should be mailed; and

The requester’s signature.      

After receiving a request that meets these requirements, the Plan will act in a reasonable and prompt fashion to provide the Certificate.