Request a Certificate of Creditable Coverage

Request a Certificate of Creditable Coverage when you are changing insurance carriers and want to prove that you have had continuous coverage. Creditable coverage can reduce or eliminate waiting periods imposed by some health plans.

Your First Name*:
Your Last Name*:
Your Company Name*:
Member ID*:
Phone*:	(xxx-xxx-xxxx)
Address*:
City*:
State*:
Zipcode*:
Email Address:
Comments:
*Required fields