Understanding Significant Break in Coverage (Health Care): Key Insights
Definition & Meaning
A significant break in coverage refers to a period during which an individual does not have any creditable health insurance for 63 consecutive days or more. This lapse means that the individual is without health coverage, which can affect their eligibility for certain health insurance options in the future. For instance, if a person named A enrolls in a group health plan on January 1, 2006, but had no insurance from February 1, 2005, to August 1, 2005, they would experience a significant break in coverage during that time.
Legal Use & context
This term is primarily used in health care law and insurance regulations. It is important in contexts such as:
- Determining eligibility for health insurance plans.
- Assessing penalties or exclusions related to pre-existing conditions.
- Understanding state-specific health insurance policies.
Users may find legal forms and templates helpful for navigating issues related to significant breaks in coverage, especially when applying for new health insurance or disputing coverage gaps.
Real-world examples
Here are a couple of examples of abatement:
Example 1: If a person named B had health coverage from January 1, 2020, to March 1, 2020, and then did not have coverage until September 1, 2020, they would have a significant break in coverage of 183 days.
Example 2: (hypothetical example) A person named C enrolls in a new health plan on June 1, 2023, but had no insurance from February 1, 2023, to May 31, 2023, resulting in a significant break in coverage of 120 days.