Required Documents for Proof of Coverage for Reimbursement
To successfully claim reimbursements for medical expenses or premiums, proof of coverage documentation must meet specific criteria. Below, we outline the necessary details and acceptable document formats.
Eligibility criteria also play a crucial role when seeking reimbursements, as your health plan must meet specific standards such as being an individual policy that satisfies Minimum Essential Coverage (MEC).
General Documentation Requirements
Eligibility Requirements for Reimbursement
To qualify for reimbursement, your health plan must meet these conditions:
Qualifying Health Plan: The plan must be an individual policy that meets Minimum Essential Coverage (MEC). Examples include ACA-compliant plans purchased via Healthcare.gov, state marketplaces, or directly from insurers. Nonqualifying plans include short-term policies, fixed indemnity plans, and health care sharing ministry plans.
When submitting proof of coverage, the following details must be included:
Name: The document must display the name of the HRA-eligible person. If you are not the primary insured individual, it must clearly indicate that you are a covered dependent.
Premium Amount: If claiming reimbursement for premiums, the monthly or annual premium amount must be visible.
Date: A current date should be shown on the document, typically within the last 30 days, to meet compliance requirements.
Plan Name and Provider: The document must identify the health plan and its provider, such as the metal tier (e.g., Gold/Silver/Bronze) and the insurer’s logo or name.
Backdated Coverage Statement: If you are claiming for premiums from a prior period, you must include a statement confirming coverage during those months.
Acceptable Document Types
You may use one or more of the following document types, provided they collectively include all required details:
Be sure to log in to your Take Command member portal to upload these documents through the designated submission process for reimbursement.
A monthly insurance bill.
An Election of Benefits document.
A health insurance card (e.g., Medicare-eligible users can submit the Red, White, and Blue Medicare card).
An SSA letter confirming Medicare premiums deducted.
A billing statement from Medicare.
A screenshot of the enrollment confirmation page.
An email confirming enrollment.
A healthcare.gov or state marketplace confirmation.
Screenshots from your online insurance member portal.
Note: Screenshots of payment history alone are not sufficient proof of coverage.
Specific Considerations for Claims
When seeking premium reimbursement, upload the required documents so they can undergo compliance review. After approval, eligible amounts (including retroactive premiums, if applicable) will be reported for reimbursement.
It is permissible to submit multiple documents if, together, they provide all required information (e.g., one document may show the plan details while another confirms the premiums).
Tips for Approval
Ensure the document is clear and legible.
Double-check that all required information is included.
If submitting a claim for retroactive periods, make sure the backdated statement is prominently displayed.
Additional Requirements for Annual Renewal
If you're renewing your individual health insurance for a new policy year, update the proof of coverage and premium documents in your Take Command account for continued reimbursement. Always check for any additional requirements in your portal.
Special Situations
Choosing Plans Outside of Take Command
Employees are not required to purchase plans directly via the Take Command platform. You can choose any qualifying health plan and submit proof of coverage in the member portal for reimbursement.
Rehired Employees
If you are rehired and wish to resume reimbursement:
Log in to Take Command.
Upload proof of coverage for your health plan.
Wait for review and approval for reimbursements to resume.
Marketplace HRA Entry Dates
When entering your HRA offer dates into the marketplace, use the coverage year’s start and end dates, such as 01/01/YYYY as the start date and 12/31/YYYY as the end date. These can be adjusted if necessary after submission.
By adhering to these guidelines and providing complete documentation, you can ensure smooth and timely reimbursement processing. Related Topics: