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Certificate of Creditable Coverage

What is a CoCC?
A CoCC is a document that serves as evidence of prior health care coverage for reducing how much or how long a health care plan can exclude a person from coverage for a preexisting health condition. For former TRICARE beneficiaries, the certificate serves as evidence for a new insurance carrier that beneficiaries had previous health care coverage under TRICARE, for the period noted on the certificate.

Who is eligible to receive a certificate?
Any person who was covered previously under TRICARE and loses eligibility, including an active duty member who separates from the Service, is entitled to receive a CoCC. An active duty member who retires does not lose eligibility. However, if retired members need a certificate to present to a new employer’s health plan, they should request one in writing.

Some examples of when certificates may be issued include the following:

  • 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 a dependent child.
  • Upon loss of eligibility for TRICARE Young Adult (age 26), a certificate will be issued to the young adult.
  • Upon loss of coverage after divorce, a certificate will be issued to the former spouse.
What type of information does the certificate contain?
Certificates issued automatically reflect the most recent period of continuous coverage under TRICARE. Certificates issued upon request of a beneficiary will reflect each period of continuous coverage under TRICARE that ended within the 24 months prior to the date of loss of eligibility. Each certificate identifies the name of the sponsor or family member for whom it is issued, the dates TRICARE coverage began and ended, and the certificate issue date.

When is a certificate required?
A CoCC is usually required when changing from one insurance plan to another. Former TRICARE beneficiaries who either purchase or are offered health care coverage may be required by the other insurance plan to present a CoCC. For example, if a Service member leaves active duty and seeks a job with a civilian employer, the new employer may require a CoCC for reducing the time the new health plan can keep the member from receiving health care for a preexisting condition under the employer’s new health care plan.

Does the TRICARE health plan require a CoCC?
No, TRICARE does not exclude preexisting conditions, so there is no need for a CoCC from a previous health plan.

Who issues the CoCC?
The Defense Manpower Data Center Support Office (DSO), as the custodian of the Defense Enrollment Eligibility Reporting System (DEERS), will issue a CoCC to sponsors and family members upon loss of eligibility. Certificates are issued automatically. However, eligible retirees or those who may have lost their certificate may still request a certificate in writing, which will be delivered through the mail to the sponsor or family member free of charge.

If I need to send my request for a certificate in writing where should I send it?
Your written request for a CoCC should be sent to the DSO at the following address:

Defense Manpower Data Center Support Office (DSO)
Attn: Certificate of Creditable Coverage
400 Gigling Road
Seaside, CA 93955-6771

The request must include the following:

  • 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
  • Signature of the requester
If there is an urgent need for a CoCC, you can fax your request to the DSO at (831) 655-8317 or request that DSO fax it to a particular number.

I’m a member of the Reserve Component (RC) called to active duty service for several periods. How will the CoCC reflect these periods of coverage?
It depends on how long you were mobilized, whether you were eligible for the Transitional Assistance Management Program (TAMP), and whether you had a break in health care coverage of 63 days or more. Below are some possible scenarios:

    Scenario 1
    A National Guard or Reserve member is mobilized for 45 days, but is not eligible for TAMP (such as National Guard or Reserve 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.

    Scenario 2
    A National Guard or 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.

    Scenario 3
    A National Guard or Reserve member is 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. By law, if an individual incurs a 63-day break in coverage, all previous creditable coverage prior to the break is disregarded (i.e., the individual would be treated as if they were not TRICARE eligible during this period) and reduces any future preexisting condition exclusion period. Also, because National Guard and Reserve members on active duty orders for 30 days or less are excluded, these periods of active duty service will not be considered when calculating length of coverage.
Is there a telephone number or website to receive additional information?
Yes. For questions regarding the CoCC, 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 Defense Health Agency HIPAA Program Office at HIPAATCSImail@dha.mil. Additional HIPAA information is available on the TRICARE Web site at http://www.tricare.mil/certificate.

* For TRICARE HIPAA Privacy and Security pages, please click here.

“On October 1, 2013, the Department of Defense established the Defense Health Agency (DHA) to manage the activities of the Military Health System. These activities include those previously managed by TRICARE Management Activity (TMA), which was disestablished on the same date. During the next several months, all TMA websites will change to reflect the new DHA. We appreciate your patience during this transition."
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