CERTIFICATE OF CREDITABLE COVERAGE UPDATE:

   A Certificate Of Creditable Coverage (CoCC) is usually required when changing from one health insurance plan to another and serves as evidence of prior health care coverage to reduce how much or how long a health care plan can exclude a person from coverage for a pre-existing health condition.  The certificate shows the new insurance carrier that a beneficiary had Tricare coverage for the period noted on the certificate. 

Certificates identify the name of the sponsor and/or family member for whom it is issued, the dates Tricare coverage began and ended, and the certificate issue date. Those issued upon request of a beneficiary will reflect each period of continuous coverage under Tricare that ended within 24 months prior to the date of loss of eligibility. The Defense Manpower Data Center Support Office (DSO), as the custodian of the defense enrollment eligibility reporting system, is the issuing authority. They issue a certificate to sponsors and family members upon loss of eligibility, including active duty members who separate from service. An active duty member who retires does not lose eligibility and is not automatically issued a CoCC. However, when retired member needs a certificate to present to a new employer for health plan coverage, he/she should request one in writing. Examples of when certificates may be issued include:

    •    Upon separation of the sponsor from active duty, a certificate will be issued to the sponsor listing all eligible family members.
    •    Upon the loss of eligibility for a dependent child (age 21, or 23 if a full-time student), a certificate will be issued to dependent child.
    •    Upon loss of coverage after divorce, a certificate will be issued to the former spouse.

    By law, if an individual incurs a 63-day break in coverage, all previous creditable coverage before the break is disregarded (meaning the beneficiary does not show as Tricare eligible during that 63-day period) which may reduce any future pre-existing condition exclusion period. Guard/reserve members on active duty orders for 30 days or less are not issued CoCC’s because they are not Tricare eligible and that time is not considered when calculating the length of coverage. Eligible retirees or those who may have lost their certificate may submit a written request for a CoCC, which will be mailed to the sponsor or family member without charge. Certificates cannot be requested by phone from the DSO. Written requests for a CoCC must include the sponsor's name and social security number, name of person for whom the certificate is requested, reason for the request, name and address to whom and where the certificate should be sent, and signature of the requester.

The mailing address for a CoCC request is: Defense Manpower Data Center Support Office (DSO), Attn: Certificate Of Creditable Coverage, 400 Gigling Road, Seaside, Ca 93955-6771. If there is an urgent need for a CoCC, a beneficiary can fax his/her request to the DSO at (831) 655-8317 or request (via mail or fax) that the DSO fax it to a particular number.  Note:  Tricare does not exclude preexisting conditions, so there is no need for a CoCC from a previous plan when a beneficiary becomes Tricare eligible.

         Content of CoCCs for members of the guard and reserve called to several periods of active duty depends on how long the member was mobilized, whether he/she was eligible for transitional assistance management program benefits, and whether the member had a break in health care coverage of 63 days or more. Some possible scenarios for issuance are:

    •    Member mobilized for 45 days, but not eligible for TAMP (such as RC members called to active duty for special work or a similar non-contingency period of active duty). The certificate issued covers the initial 45-day period. Thirty days later, the member is mobilized for 60 days (again not eligible for TAMP), and the break in coverage is less than 63 days. The second certificate will cover the 60-day period. The member may then present these collective certificates to a health plan and receive credit for the total coverage time.
    •    A guard/reserve member is mobilized for 45 days but eligible for 180 days of TAMP coverage.   The certificate is issued at the end of the 225-day period, indicating continuous coverage for 225 days.
    •    A guard/reserve member was covered for 18 months, which is followed by a break in coverage of 63 days or more. The 18-month period that occurred prior to the 63-day break in coverage will not be credited on the certificate of creditable coverage. By law, if an individual incurs a 63-day break in coverage, all previous creditable coverage prior to the break are disregarded (meaning you were not Tricare eligible during this period) and reduces any future preexisting condition exclusion period. Also, since rc members on active duty orders for 30 days or less are excluded, these periods of active duty service will not be considered when calculating your length of coverage.

    For questions regarding the Certificate Of Creditable Coverage, sponsors and family members may contact the DSO at (800) 538-9552. For TTY/TDD, dial (866) 363-2883. Questions also may be sent via e-mail to the Tricare Management Activity HIPAA program office at hipaamail@tma.osd.mil .  Additional CoCC information is available on the Tricare web site at www.tricare.mil/hipaa/downloads/cocc.pdf.  [Source: CoCC Fact Sheet www.tricare.mil/Factsheets/print.cfm?id=247. 17 Nov 08 ++]

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