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Creditable Coverage 101

What Should Be In A Certificate Of Creditable Coverage?

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First of all, don't look for a real certificate. Even though they're called certificates, don't expect something with a fancy border that's suitable for framing. A Certificate of Creditable Coverage is usually just a computer generated letter that gives the start and stop dates of your coverage.

No matter what form is used, it must contain the following information:

  • The date coverage was started.
  • The name of the group plan providing the coverage.
  • The name of the employee or dependent to which the Certificate applies as well as any information needed to identify the person under the plan such as the plan Identification numbers or, for dependents, the employee's name.
  • The name, address, and telephone number of the plan or insurer required to provide the certificate.
  • A telephone number to call for further information if the telephone number is different than the phone number of the plan or insurer required to provide the Certificate.
  • Either (1) a statement that the person has at least 18 months creditable coverage without a significant break or (2) the date any waiting period began and the date Creditable Coverage began.
  • The date Creditable Coverage ended or an indication that it is still continuing.

A single Certificate may provide information for the participant and dependents even if the information is different, as long as the different information is separately stated.

Certificates of Creditable Coverage must be issued within 14 days following termination of coverage. Certificates must be provided in writing to the person losing coverage unless:

  • The person losing coverage requests it be sent to another party (such as the new insurance carrier); and
  • The receiving party agrees to accept the information in another form.

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