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Creditable Coverage 101


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Basically, "Creditable Coverage"  is health  insurance coverage. It is a concept created by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and is relevant in two instances:

  • HIPAA provides that when you obtain health insurance from a new employer, you cannot be subjected to a waiting period during which your existing health condition will not be covered if you previously had what is referred to as "Creditable Coverage." 
  • HIPAA also provides that if you lose your employer based health insurance you can convert to an individual health insurance policy.

In both instances, the protections are triggered by having a history of "Creditable Coverage." Proof of that history is contained in a Certificate of Creditable Coverage.

NOTE: If a new employer or insurer do not ask about prior coverage, submit the Certificate voluntarily. (We provide a sample cover letter.) It will save a time delaying hassle if you have a claim.

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