What is a Loss of Coverage Letter?

When enrolling in insurance coverage outside of Open Enrollment due to a loss of coverage, supporting documentation is required.  You will need to provide a Loss of Coverage Letter or if you lost an employer sponsored plan, a letter from your previous employer.

Loss of Coverage Letter – Letter from your previous health carrier indicating an involuntary loss of coverage.  The supporting document must also indicate your name and the end date of your previous health coverage within 60 days from the day your application was submitted. 

Letter from your previous employer - This letter must be on company letterhead and signed by your previous employer indicating the involuntary loss of coverage along with the end date of your coverage.

    Example of an acceptable document from a previous health carrier

    The Certificate of Creditable Coverage (COCC) below is a good example of a loss of coverage document because it has the official insurance carrier logo at the top of the page and includes the name of the member to whom it applies as well as the coverage effective date and end date.

    April 28, 2017

    John Doe

    1313 Mockingbird Lane

    Chelmsford, MA 01824

    Group Health Benefit Plan Certification of Coverage

    This certificate of prior credible coverage describes periods of group health coverage administered by one or more of United HealthCare’s affiliated companies that provide insurance.

    As required by the Health Insurance Portability and Accountability Act of 1996, we acknowledge that the following individual(s) participated in a group health benefit plan:

    Group Name: Acme Inc

    Group Number: 3263827

    Participant name



    Coverage Period Begin Date

    Coverage Period End Date

    John Doe





    Jane Doe





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