A group health plan or an issuer offering coverage in connection with a group health plan must allow an employee who is eligible, but not enrolled, to become covered under the plan. Dependents are also allowed to enroll, if family coverage is provided under the terms of the plan. If a person becomes a dependent through marriage, birth, adoption, or placement of adoption, the person may enroll as a beneficiary. If not already enrolled, the employee and spouse may enroll at this time. Creditable coverage certificates must be provided by a plan when an individual ceases to be covered.
Regulations provide a model certificate.
Creditable coverage includes coverage of an individual under many types of group health plans, including health insurance from the group or individual market, Medicare, Medicaid, military plans, risk pools, or Federal Employee Health Benefits programs. Certification requirements are met if another party provides the certificate. A certificate must be provided upon request even if the individual has previously received a certificate. The Regulations permit individuals to establish creditable coverage through means other than certificates. The McGuireWoods homepage is intended to provide information of general interest to the public and is not intended to offer legal advice about specific situations or problems.