Insurance Agent Forum

[newmindfashion]

Here's a scenario:

I prospect called today who was turned down by a number of carriers for a pre-existing condition. He purchased a Mega catastrophic accident plan (not from me). He may be able to form a 1 person Group here in CT but needs to have been in business for at least 90 days.

In the meantime, will this catastrophic accident plan serve as prior creditable coverage while he waits to form his group plan? My understanding is that any health insurance, Group or Individual is considered prior creditable coverage, even the old basic surgical expense policies. However, does an accident-only catastrophic plan meet the criteria.

I read up on some HIPAA law and it just says
"Most health coverage is creditable coverage, such as coverage under a group healthplan (including COBRA continuation coverage), HMO, individual health insurancepolicy, Medicaid or Medicare.
Creditable coverage does not include coverage consisting solely of 'excepted benefits,' such as coverage solely for limited-scope dental or vision benefits."

Not sure if accident only plans fit that last part.

Everyone's opinions are appreciated.

[healthagent]

I would imagine it would have to actually be "insurance" to meet credible coverage requirements. Is this an accident "plan" or accident "insurance?" I believe if it's underwritten you might be in good shape.

[somarco]

Jesse -

Check with your state DOI.

GA for example considers STM to be creditable coverage but some states (OH for example) do not.

HIPAA is a federal law but administered at the state level. Each state is required to have their own "HIPAA" legislation in place that can be more liberal than the federal law but not more stringent. CT may allow such plans as creditable while other states may not.