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What is Creditable Coverage (Health Care) and Why It Matters
Definition & Meaning
Creditable coverage refers to health insurance that an individual had prior to enrolling in a new health plan. This coverage must not have been interrupted by a gap of 63 days or more. It is important to note that creditable coverage does not include limited benefits such as dental, vision, or other supplemental plans. The duration of creditable coverage can help reduce or eliminate waiting periods for pre-existing conditions under the new health plan.
Table of content
Legal Use & context
Creditable coverage is a significant term in health insurance law. It is primarily relevant in the context of health care regulations and benefits administration. Understanding this term can assist individuals in navigating their health insurance options, particularly when transitioning between plans. Users can often manage these transitions using legal forms available through services like US Legal Forms, which provide templates for health insurance applications and related documents.
Key legal elements
Real-world examples
Here are a couple of examples of abatement:
(hypothetical example) Jane had health insurance through her employer for three years. After leaving her job, she enrolled in a new health plan within 30 days. Because she maintained continuous coverage, her previous insurance qualifies as creditable coverage, allowing her to avoid a waiting period for pre-existing conditions.
Relevant laws & statutes
Pursuant to 26 USCS § 9801(c)(1), creditable coverage is defined and outlined. This statute specifies the types of coverage that qualify and the exclusions that apply. Additionally, the Health Insurance Portability and Accountability Act (HIPAA) also addresses issues related to creditable coverage.
State-by-state differences
Examples of state differences (not exhaustive):
State
Notes
California
State law may provide additional protections for continuous coverage.
Texas
Similar to federal guidelines, but specific state regulations may apply.
New York
State laws may expand definitions of creditable coverage.
This is not a complete list. State laws vary, and users should consult local rules for specific guidance.
Comparison with related terms
Term
Definition
Difference
Pre-existing condition
A health issue that existed before obtaining new health coverage.
Creditable coverage can mitigate waiting periods for these conditions.
Excepted benefits
Benefits that do not count as health insurance coverage.
Creditable coverage excludes these benefits.
Common misunderstandings
What to do if this term applies to you
If you believe you have creditable coverage, gather documentation of your previous health insurance. When applying for a new plan, provide this information to ensure you receive appropriate benefits. Consider using US Legal Forms to access templates for health insurance applications. If your situation is complex, it may be beneficial to consult with a legal professional.
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