Creditable Coverage Creditable coverage is health care coverage as defined under the Health Insurance Portability and Accountability Act (HIPAA). Creditable coverage includes comprehensive medical coverage under group health plans, individual health insurance, Medicare Part A, state health benefit risk pools, and public health plans such as Medicaid or the Children’s Health Insurance Program. A participant will receive credit for prior creditable coverage that occurred without a break in coverage of 63 days or more. Any coverage occurring prior to a break in coverage of 63 days or more will not be credited against a pre-existing condition exclusion period.
Transferring Within The Plan If an employee transfers between employer units, begins full-time employment with the new employer unit at any time during the following month, and completes an Application for Coverage form within 31 days of his date of employment, there will be no break in coverage.
The employee may choose Base Coverage or Select Coverage at this time. Each coverage type is independent of the other; therefore, there is no deductible or out-of-pocket credit if an employee changes coverage types when transferring to a new employer unit during the year. The employee may also add eligible dependents at this time and may apply for High Option for Children. The employee must complete an Application for Coverage form with the new employer unit within 31 days of his date of employment.
Coverage During the Summer Months for Employees of a School District, Community/Junior College, or University
A covered school employee who is off for summer recess is entitled to continuous insurance coverage during the summer months.
A covered school employee who leaves one employer unit at the end of the school year, does not work for an employer unit during the summer months, and becomes employed by another employer unit when the school calendar resumes in the fall, will remain covered by the old employer unit until August 31st. Coverage with the new employer unit will begin September 1st.
Covered by old employer
Covered by new
unit Through August 31st
employer unit Beginning September 1st
A covered school employee who leaves one employer unit at the end of the school year, and becomes employed by another employer unit during the summer months will remain covered by the old employer unit until the end of the month in which the employee transfers. Coverage under the new employer unit will be effective on the first of the month following the transfer.