Question:
Am I reading this correctly?- An insurance question.

Okay, I need help here. I understand the law about pre-existing conditions, etc. I am confused about "creditable coverage". I know it is about the lapsing between insurance companies/coverage. My question is this- Is the lapse included in the "insurance coverage begins 90 days after hire date"? I was layed off from my previous job on Oct. 29 where I had BC/BS. On Nov. 1, I began my current job. I picked up the insurance (Pacific Life and Annuity) the minute it was available (at the 90 day mark). So, does creditable coverage apply here? I am assuming it does otherwise you could not use it unless you were lucky enough to get new coverage at a new job before the normal 90 day waiting period. The reason I am asking this is because I had another surgery a couple of months ago and it is now pending to see if my insurance should pay at 70% or at 50% (since I had the surgery with the initial 6 month waiting period). If they take my previous insurance as creditable coverage then I will only have to pay 30%, not 50%. What do you think? Does this make sense? I hope so.    — karmiausnic (posted on June 28, 2002)

June 27, 2002
Yes, creditable coverage would apply. As long as there is no lapse of insurance coverage for 63 days or more,EXCEPT where you start with a new employer and the waiting period DOES NOT count against you as long as you sign up as soon as the waiting period is over. Basically, your ok.
   — Patty H.

June 28, 2002
By definition, Creditable Coverage is "The period of any preexisting condition exclusion that would otherwise apply to an individual under a group health plan is reduced by the number of days of creditable coverage the individual has as of the enrollment date." The definition comes straight from the HIPAA (Health Insurance Portability and Accountability Act) regulations. Creditable coverage includes Group Health plans, individual insurance, Medicare, Medicaid, Military Benefits, Medical Care programs of the Indian Health Services, Federal Plans, etc. Pretty much any prior medical coverage that you had is "credited" towards the pre-existing condition period imposed by your new carrier/employer - provided there is no significant break (63 days) in coverage. As far as waiting period, they run concurrent with pre-existing condition limitation periods, they do not count as creditible coverage and waiting periods on group health plans are not considered a break in coverage. As an example, let's assume there is a 90 day waiting period;a 365 day pre-ex exclusion and; 200 days of Prior Creditable Coverage. Take the 365 day pre-ex exclusion, subtract the 200 days of creditable coverage..that leaves you with a 165 day applicable pre-ex period. From those 165 days subtract the 90 day waiting period; you're left with a total pre-ex time of 75 days that would apply under the employers group health plan. I hope this helps and not confuses!
   — Rosario T.