What is a HIPAA Certificate of Credible Coverage?
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Identification
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The certificate of credible coverage concerns the letter "P" in HIPAA for portability. HIPAA allows a patient to port his prior health coverage to a new group plan for purposes of preexisting conditions. Group health plans may limit coverage for a preexisting condition for no more than 12 months.
Significance
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Creditable coverage is designed to give a patient credit for prior health coverage. For each day she had coverage under a prior health plan, she may obtain credit against the 12-month exclusion period available to insurers for preexisting conditions.
Considerations
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When an individual's employment is terminated, a formal certificate is automatically issued; he can also request this certificate. The certificate demonstrates to a new group the period that the new enrollee had coverage. Credit for prior coverage is lost, however, if a break in insurance coverage occurs for 63 days or more.
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