Understanding Creditable Coverage: Requesting a Notice from Your Employer

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that health insurance providers be willing to provide certain information to their members to help them transition from one insurance plan to another with minimal complications. One important concept covered by this act is known as "creditable coverage." Upon request, health insurance providers must supply any member with either a "Notice of Creditable Coverage" or "Certificate of Creditable Coverage" to document the member's health insurance coverage.



A "Notice of Creditable Coverage" is used to supply coverage information to Medicare offices, and a "Certificate of Creditable Coverage" is used to supply coverage information to private insurance companies. If you are applying for Medicare, you will need a "Notice of Creditable Coverage." Otherwise, a "Certificate of Creditable Coverage" will work.

Things You'll Need

• Name of health insurance provider
• Member's health insurance policy number
• Contact phone number for health insurance provider
• Telephone

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Instructions

• 1

  Call your health insurance provider using the member benefits number listed on your insurance card.

• 2

  Request either a "Notice of Creditable Coverage" or a "Certificate of Creditable Coverage" be mailed to your home address. (Some insurance companies will email or fax the letter to you at your request.)

• 3

  Provide the letter to the Medicare office or your new medical insurance company to prove you had existing health insurance coverage when you applied for new benefits.