Credit for Prior Coverage & HIPAA Eligibility

Credit for Prior Coverage
The nine-month waiting period for pre-existing conditions will be shortened one day for each day you had creditable coverage under another health plan, provided:

You were enrolled in comprehensive group or individual coverage at any time during the 63-day period immediately preceding the date of application and the benefits under your previous health plan were equivalent to or greater than the new plan you are applying for:

You and your dependents are seeking coverage because of a change of residence within Washington State and your current medical coverage is not offered in the new area and application is made within 90-days of relocation and you were enrolled at any time during the 63-day period immediately preceding the date of application for comprehensive coverage;

You or your dependents are seeking coverage because your current health care provider is no longer part of your current carrier's provider network and is part of the new company's network of providers and application is made within 90 days of your provider leaving your current carrier's provider network and you were enrolled at any time during the 63-day period immediately preceding the date of application for comprehensive coverage.

HIPAA Eligibility
The nine-month waiting period for pre-existing conditions will be waived if you are eligible as defined by 2741(b) of the Federal Health Insurance Portability and Accountability Act (HIPPA) of 1996 (42 U.S.C. 300gg-41(b)).

A HIPAA Eligible individual is defined as someone:

Who has at least 18 months of prior creditable coverage
Whose most recent prior creditable coverage was under a group health plan, government health plan, or church plan and was not terminated for fraud or nonpayment of rate
Who is not eligible for coverage under a group plan, Medicare A or B, or Medicaid and does not have other health coverage, and;
Who elected and exhausted any COBRA continuation or similar state extension of coverage, which they were offered.

If you meet the requirements for any of the conditions listed under Credit for Prior Coverage & HIPAA eligibilty, pre-existing condition waiting periods will be credited upon receipt of a Certificate of Creditable Coverage from your prior insurance carrier. A Certificate of Creditable Coverage will be issued to you by your prior insurance carrier upon termination of your plan. Please contact your prior insurance carrier for more information.