Certificate of Creditable Health Coverage Under
the Health Insurance Portability and
Accountability Act of 1996 (HIPAA)
What is Creditable Coverage?
The Health Insurance
Portability and Accountability Act of 1996 (HIPAA)
ensures that individuals, who qualify, are
provided continuous coverage for ongoing medical
treatment. This may reduce how much or how long
a health plan can keep a person from getting
coverage due to pre-existing conditions. If
there is a break in coverage of 63 days or more,
the coverage prior to the break in coverage
cannot be counted as creditable coverage.
What is a Certificate of Creditable
Coverage?
A Certificate of Creditable
Coverage is a document that serves as evidence
of your health coverage under AHCCCS Health
Insurance, which includes Medicaid or the State
Children Health Insurance Program (SCHIP) for
the period of time noted on the certificate.
Why Do I Need This?
You may need to furnish this
certificate if:
- you become eligible under a group
health plan with your employer that excludes
coverage for certain medical conditions that you
have before you enroll
- if you obtain coverage
under a group health plan that is not
affiliated with your employer
- if you are buying an
individual policy.
This certificate may
need to be provided if medical advice,
diagnosis, care or treatment was recommended or
received for the condition within the 6-month
period prior to your enrollment in the new plan.
Who Can Get a Certificate?
Any person who received full
coverage under AHCCCS within the last 24 months
is eligible to receive a Certificate of
Creditable Coverage.
If you are a non-citizen and
received ONLY emergency services, then this
certificate cannot certify full coverage. If you
are not sure of your level of coverage under
AHCCCS, ask us.
How Do I Get A Certificate?
Contact: AHCCCS Administration
Member Services Unit (602) 417 - 7070 or
1-800-654-8713, extension 7070.
Your request must include the
following:
- Name of person for whom the
certificate is requested
- Social Security
number or the person’s AHCCCS ID number (this
can be found on your AHCCCS ID Card)
- Name and
address to whom and where the certificate should
be sent
Statement of HIPAA Portability Rights
[PDF, 37 Kb]
(Posted June 14, 2005)
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