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Creditable Coverage 101

What Is Creditable Coverage?

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Creditable coverage is health insurance coverage of almost any type. Creditable coverage includes health coverage under:

  • A group health plan, whether the plan is through an insurance company or is self insured by the employer
  • An individual health insurance policy of almost every type, including fee-for-service (indemnity) plans, HMOs, PPOs, and POS.(For more information on these plans, see Health Insurance). Policies which cover hospitalization, but not medical services are included. Limited benefit Hospital Indemnity-type plans that pay, for example $100 per day of hospital confinement, do not count as Creditable Coverage
  • COBRA (provided the COBRA coverage occurred without a break in coverage of 63 days or more).
  • Medicare
  • Medicaid
  • Federal Employees Health Benefits
  • Coverage under the Indian Health Service
  • Coverage through the Peace Corps
  • A state health insurance high risk pool
  • Military health insurance (CHAMPUS)
  • Health coverage provided by a government entity such as Guam's StayWell Insurance or even a foreign country's national health plan

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