Creditable coverage under HIPAA

Majority of health coverages are creditable coverage like coverage under a group health plan, individual health insurance policy… The creditable coverage does not include coverage consisting solely of excepted benefits like coverage solely for limited scope dental.

Days in a waiting period (no coverage) are not creditable coverage under the plan, nor are these days taken into account when determining a significant break in coverage (normally a minimum of 63 days).  This 63 day break period may be extended under state law if your coverage is insured through an insurance company or offered through an HMO.

With the standard method, a person receives credit for his previous coverage that occurred without a break in coverage of minimum of 63 days.  Any coverage occurring prior to a break in coverage of 63 days or more is not credited against a preexisting condition exclusion period.

Fo example, a person had coverage for 2 years followed by a break in coverage of 70 days and then resumed coverage for 8 months.  This person would only receive credit for 8 months of coverage; no credit would be given for the 2 years of coverage prior to the break in coverage of 70 days.

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