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 indicate your name, the names of any dependents that were covered under the prior plan and the date the previous health coverage ended. The date the previous health coverage ended must be within 60 days from the date your application was submitted. 

Letter from your previous employer - This letter must be on company letterhead or stationery with the employer’s signature.  It must indicate your name, the names of any dependents that were covered under the prior plan and the date the previous health coverage ended.

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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