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This Web site contains a compilation of more than a thousand consumer finance  columns written by Tony Novak from the 1980s through 2006, updated and reformatted for maximum usefulness today.  New material was added after 2010.

Content is the opinion of the author and does not represent the position of any other person or entity. Information is from sources believed to be reliable but cannot be guaranteed.

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Certificate of creditable coverage

originally posted: 11/22/2006  reposted: 2/18/2011 This post has not been recently reviewed or revised by the author and may be out of date. If you notice an error or are in doubt, please send a new question by email or ask for an update. Email asktony@tonynovak.com.

Q: I currently have individual health insurance and have rheumatoid arthritis. I've had this policy for some 10 years. If I go to work for a company that provides me with group insurance, will my pre-existing condition be covered? Or will I have to endure a waiting period? I thought that as long as I could produce a letter showing "creditable coverage", that I would be covered for any pre-existing conditions, but I just spoke with someone who is an HR person, who said that no, the letter of creditable coverage wouldn't do me any good, that I wouldn't be covered for the pre-existing condition, although she didn't elaborate on the period I would have to wait. Is she right? I was thinking since I had not had any lapses in insurance coverage for the past 10 years, that I would be covered from the start. She said that would be true if I was coming from a company where I had group benefits, but not if I'm coming from an individual health insurance policy. Is that correct? I didn't think it mattered whether I was coming from an individual policy or a group policy as long as I could prove "creditable coverage"?

A: You are correct. The federal law known as HIPAA that guarantees this continuous coverage under any employer provided group insurance plan applies when you have proof of creditable coverage either from an individual health insurance or another group insurance. Your new insurance carrier will be familiar with this procedure even if the personnel office is not. This is why it is so important to maintain some type of permanent or short term medical insurance while between jobs. Otherwise, the takeover benefit of pre-existing conditions is lost, and you must satisfy another 6 month waiting period all over again. The following clarifications probably do not apply to you but are listed here just for other readers: 1) Some types of health insurance like supplemental plans and international medical insurance do not qualify as "creditable coverage" 2) A few states define "creditable coverage" differently for purposes of admission into the state's assigned high risk open enrollment insurance pool. See the enrollment requirements for your specific state plan.

Summary

More resources:

article: "Understanding a 'Certificate of Creditable Coverage'"