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Creditable Coverage 101

What To Do If The New Insurer Does Not Request A Certificate Of Creditable Coverage

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If an insurance company follows the general practice and does not request information about your previous coverage at enrollment, you're not out of the water. The standard practice is for health insurance companies to wait until a claim is submitted, then examine it to see if the claim relates to a "pre-existing" condition. If it does, many companies just go ahead and deny claims relating to pre-existing conditions and leave it to you to show that it should be covered.

To avoid that delay and hassle, we suggest:

  • As soon as you become covered under a new plan, call the Claims office of the new insurance company. The telephone number will be on your insurance ID card.
  • Tell the claims person that you are newly insured and want to provide the insurance company with your Certificate of Creditable Coverage so any pre-existing claims will not be denied.
  • Don't let the person at the insurance company distract you with questions about a particular condition and whether or not it's pre-existing. You just want to present the Certificate so the issue does not come up at a later time.
  • Ask for a name and mailing address of the person to whom the Certificate should be sent.
  • Make a copy of the Certificate for yourself. Then send the original of the Certificate via a means by which you can get a receipt showing delivery (by Registered mail, Return Receipt Requested or by an overnight service), with a cover letter such as the following sample:

 

Your return address
Your telephone number

Date

Name and address of the Claims Person
at the insurance company

RE: Name of Employer , Group Health Insurance

Dear Mr/Ms XXXXXXXXXX:

Enclosed is my Certificate for Creditable Coverage from my prior insurer.

As you will note, the Certificate confirms that I have Creditable Coverage to be applied against any Pre-Existing Conditions Waiting Period in your plan.

If you have any questions, please let me know.

Very truly yours,

 

Your name


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