Creditable Coverage

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Creditable Coverage


♦ Prior to 2014, a job-based plan could impose a pre-existing condition exclusion period for up to 12 months unless you could prove you had creditable health insurance coverage prior to enrolling in you employer's plan.

Examples of creditable health insurance coverage:

• Group health plan — Individual health insurance — Student health insurance

• Medicare — Medicaid — CHAMPUS and TRICARE

• Federal Employees Health Benefits Program

• Indian Health Service — Peace Corps

• Public Health Plan (any plan established or maintained by a State, the U.S. government, a foreign country)

• Children’s Health Insurance Program (CHIP)

• State health insurance high risk pool.

If you had prior creditable coverage, it would have reduced the length of a pre-existing condition exclusion period under new job-based coverage.

ACA changed this

With the passage of the Affordable Care Act, job-based plans are not allowed to exclude coverage for pre-existing conditions.

The only exception to the pre-existing rule is for grandfathered health insurance plans. This would be only if the plan had been established by an employer before March 23, 2010.

Grandfathered status can be lost if the plan makes significant changes. As a result, overtime most grandfathered plans have been replaced.

Short-term health plans

These type of plans do not have to cover pre-existing conditions. And they do not have to take into consideration creditable health insurance coverage.

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