What qualifies as creditable coverage?
Creditable coverage, as defined under federal HIPAA, is considered as “creditable coverage” by Aetna, including: group health plan coverage (including a governmental or church plan), group or individual health insurance coverage, Medicare, Medicaid, military-sponsored health care (CHAMPUS), a program of the Indian Health Service, a state health benefits risk pool, the FEHBP, a public health plan as defined in the federal HIPAA regulations, and any health benefits plan under section 5(e) of the Peace Corps Act. Not included as creditable coverage is any coverage that is exempt from the law; for example, dental-only coverage, or dental coverage that is provided in a separate policy or even in the same policy as medical, if such coverage is separately elected and results in additional premium.
A52. 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.
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). 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.
