What qualifies as creditable coverage?
Creditable coverage means coverage of an individual under any of the following plans prior to the enrollment date under the policy/plan: • an employee group health plan; • Health Insurance Coverage*; • Medicare; • Medicaid; • Military health care; • A medical care program of the Indian Health Service or of a tribal organization; • A state health benefits risk pool; • A health plan offered under the Federal Employee Health Benefits Program; • A public health plan as defined under Federal regulations; • A health benefit plan under Section 5(c) of the Peace Corps Act; or • Any other health coverage considered as Creditable Coverage under state/federal law or regulations.
A34. Most health coverage is creditable coverage, such as coverage under a group health plan (including COBRA continuation coverage), HMO, individual health insurance policy, Medicaid or Medicare. Coverage consisting solely of “excepted benefits,” such as coverage solely for limited-scope dental or vision benefits is not included as creditable coverage. Days in a waiting period during which members have no other coverage are not creditable coverage under the plan, nor are these days taken into account when determining a significant break in coverage (generally a break of 63 days or more). This 63-day break period is extended under California law to 180 days if coverage is insured and both the prior and new coverages are employer sponsored. Blue Cross’ POS plans do not include preexisting condition exclusions.
Most health coverage is creditable coverage, such as coverage under a group health plan (including COBRA continuation coverage), HMO, individual health insurance policy, Medicaid or Medicare. Coverage consisting solely of “excepted benefits,” such as coverage solely for limited-scope dental or vision benefits is not included as creditable coverage. Days in a waiting period during which you have no other coverage are not creditable coverage under the plan, nor are these days taken into account when determining a significant break in coverage (generally a break of 63 days or more). 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.
