What is creditable coverage under HIPAA?
The 12-month (or 18-month) exclusion period for preexisting conditions must be reduced for creditable coverage. Creditable coverage is very broadly defined and includes coverage by a group health plan, individual health insurance, Medicare, Medicaid, military coverage, or state-provided health care such as risk pools. For plan years beginning on or after July 1, 2005, coverage under the State Children’s Health Insurance Program (S-CHIP) is also a category of credible coverage. Standard counting method. Creditable coverage may be determined by using the standard counting method or the alternative method. Under the standard counting method, the plan administrator determines the amount of an employee’s creditable coverage by determining all days during which the individual had one or more types of creditable coverage. This determination is made without regard to the specific benefits included in the coverage. If creditable coverage is derived from more than one source on a particular day,
