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Certificate of Credible Coverage Form
In the new plan. If you become covered under another health plan, check with that plan’s administrator to see if you need to provide this Certificate. You will receive credit for previous coverage that occurred without a break in coverage of 63 days or more. However, any coverage occurring prior to a break in coverage of 63 days or more may not be credited against an exclusion period. Contact your Department’s Personnel Assistant for more information. 1. Date of This Certificate: 2. Name of...Show details
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