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September 2012 NOTICE OF CREDITABLE COVERAGE FOR PERSONS WITH MEDICARE WHO ARE COVERED BY THE NEW YORK STATE HEALTH INSURANCE PROGRAM (SHIP) This important notice is being sent to all SHIP enrolled
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How to fill out notice of creditable coverage:

01
Obtain the notice of creditable coverage form from your employer or health insurance provider. This form is typically provided when you leave a job or experience a change in health insurance coverage.
02
Begin filling out the form by entering your personal information such as your name, address, and contact details.
03
Provide details about your health insurance coverage, including the name of the insurance company, policy number, and the duration of coverage.
04
Indicate whether your health insurance coverage is creditable or non-creditable. Creditable coverage means that the insurance meets or exceeds the minimum coverage requirements set by the Affordable Care Act.
05
If you are unsure whether your coverage is creditable or non-creditable, you can contact your health insurance provider or refer to the plan documents.
06
Complete the form by signing and dating it.
07
Submit the filled-out form to the appropriate party, usually your previous employer or health insurance provider.

Who needs notice of creditable coverage?

01
Individuals who are transitioning between health insurance plans or leaving a job that provided health insurance coverage may need a notice of creditable coverage.
02
Employers are required by law to provide this notice to their employees when their health insurance coverage will be ending or changing.
03
Individuals who are enrolled in Medicare or Medicaid may also receive notices of creditable coverage to ensure their continued eligibility for these programs.
04
It is important to keep a copy of the notice of creditable coverage for your records and to provide it to future health insurance providers if needed.
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The notice of creditable coverage is a document provided by group health plans or health insurance issuers to individuals who are losing coverage under the plan.
Group health plans and health insurance issuers are required to provide notice of creditable coverage to individuals who are losing coverage under the plan.
The notice of creditable coverage must be filled out by the group health plan or health insurance issuer, and should include information about the coverage being lost and any options for continuation coverage.
The purpose of the notice of creditable coverage is to inform individuals who are losing coverage about their rights to continue their health insurance coverage under COBRA or other laws.
The notice of creditable coverage must include information about the coverage being lost, the reasons for the loss of coverage, and any options for continuation coverage.
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