John Glenn School Corporation
Administrative Guidelines


The Health Insurance Portability and Accountability Act of 1996 (HIPAA) limits the circumstances under which coverage may be excluded for medical conditions present before the employee enrolls. Under the law, a pre-existing condition exclusion generally may not be imposed for more than twelve (12) months (eighteen (18) months for a late enrollee after the enrollment date). The twelve (12) month (or eighteen (18) month) exclusion period may be reduced by a new employee's prior health coverage. A new employee is entitled to a certificate from his/her former health insurance provider that will show evidence of the person's prior health coverage.

To obtain a certificate, the employee should complete the attached form and return it to:


John Glenn School Corporation


101 John Glenn Drive


Walkerton, IN 46574


For additional information contact:


(574) 586-3129

The certificate must be provided promptly. The employee should keep a copy of this completed form. S/He may also request certificates for any dependents (including a spouse) who were enrolled under the employee's health coverage.

The Business Manager will be responsible for providing a Certificate of Health Insurance Coverage (Form 4421A F1) to an employee when:

 A.s/he no longer is covered by the Corporation's plan;

 B.s/he is no longer covered under COBRA;

 C.s/he requests a certificate no later than twenty-four (24) months after cessation of coverage.

Revised 1/6/15

© Neola 2014