Creditable Coverage (Health Care) Law and Legal Definition

Creditable coverage refers to a health insurance coverage that a beneficiary had before enrolling to the current health plan and it generally includes a period of coverage not interrupted by a period of 63 or more days. Creditable coverage does not offer coverage for limited scope dental, vision, specified disease or other supplemental-type benefits. The creditable health insurance coverage period can be used to offset a pre-existing condition exclusion period of the new health plan.

Pursuant to 26 USCS § 9801(c)(1) the term "creditable coverage" means, with respect to an individual, coverage of the individual under any of the following:

(A) A group health plan;

(B) Health insurance coverage;

(C) Part A or part B of title XVIII of the Social Security Act [42 USCS §§ 1395c et seq. or 1395j et seq.];

(D) Title XIX of the Social Security Act [42 USCS §§ 1396 et seq.], other than coverage consisting solely of benefits under section 1928 [42 USCS § 1396s];

(E) Chapter 55 of title 10, United States Code [10 USCS §§ 1071 et seq.];

(F) A medical care program of the Indian Health Service or of a tribal organization;

(G) A State health benefits risk pool;

(H) A health plan offered under chapter 89 of title 5, United States Code [5 USCS §§ 8901 et seq.];

(I) A public health plan (as defined in regulations);

(J) A health benefit plan under section 5(e) of the Peace Corps Act (22 U.S.C. 2504(e)).

Such term does not include coverage consisting solely of coverage of excepted benefits (as defined in section 9832(e) [26 USCS § 9832(e)]).