Certificate of Creditable Health Coverage Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Creditable coverage is defined as coverage of the individual under any of the following types of plans:

• A group health plan
• Medicare Part A or B
• AHCCCS Health Insurance (Medicaid)
• KidsCare (Children's Health Insurance Program)
• Military sponsored health insurance (CHAMPUS)
• Medical care program of the Indian Health Service or tribal organizations
• The federal employees health benefits program
• A public health plan (a plan established or maintained by a State, county, or other political subdivision of a State that provides health insurance coverage to individuals)
• A health benefit plan under the Peace Corps Act; or
• A church plan

If there was a gap (or no coverage) in coverage of 63 days or more, the coverage before the gap can not be counted as creditable coverage.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) ensures that qualified individuals 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.

What is a Certificate of Creditable Coverage?

A Certificate of Creditable Coverage is a document that proves an individual had health coverage under AHCCCS Health Insurance or KidsCare for the period of time noted on the certificate.

Why Is This Needed?

A certificate may be needed if an individual:

• Becomes eligible under an employer's group health plan that excludes coverage for certain pre-existing medical conditions
• Obtains coverage under a group health plan that is not affiliated with the employer
• Is buying an individual policy
• Receives medical advice, diagnosis, care or treatment for a condition within the 6-month period prior to 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
• A non-citizen, who received ONLY emergency services, can not get a certificate that certifies full coverage. To determine the level of coverage under AHCCCS, contact AHCCCS Member Services Unit:
  

  Call:

  • Within Maricopa County 602-417-7000
  • Statewide 1-800-962-6690
  • Telecommunications Device for the Deaf (TDD) 602-417-4191

How to Get A Certificate?

To receive a Certificate of Creditable Coverage, a request must be made to AHCCCS Administration Member Services Unit:

Call:

• Within Maricopa County 602-417-7000
• Statewide 1-800-962-6690
• Telecommunications Device for the Deaf (TDD) 602-417-4191

The 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 the member's AHCCCS ID Card)
• Name and address to whom and where the certificate should be sent

Statement of HIPAA Portability Rights [PDF, 37 KB]