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). Minimum Essential Coverage (MEC) refers to health insurance mandated to avoid penalties under federal regulations and to qualify for reimbursement. Short-term plans, such as Pivot Health plans, typically fail to meet these requirements and are excluded from eligibility.
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. The compliance team reviews health plans to ensure they meet the IRS’s MEC guidelines.
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). When submitting claims for multiple premium payments, ensure that the uploaded documents clearly specify the details of each policy and the corresponding premium amounts.
Additionally, if you wish to transition from premium reimbursements to other eligible healthcare costs, the process is straightforward. Update your proof of coverage by setting the recurring premium amount to $0.00, making your full allowance available for eligible out-of-pocket medical expenses. Upload the updated proof of coverage, and once approved, begin filing claims for medical expenses. This only applies for HRA plans that cover medical expense submissions.
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. - Consolidate multiple documents into one file using PDF merging tools to streamline the upload process.
Wait for finalized documentation before submission, and if immediate submission is necessary, follow up with corrected versions later.
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.
How to Shop for a New Health Insurance Plan
If your current plan does not meet MEC requirements or your coverage has ended, you can shop for a new plan via the Take Command Portal:
Log in to your Take Command Portal.
Navigate to the Health Insurance tab on the left-hand side.
Click on Shop Insurance Plans on the top right.
Follow the guided steps to choose a plan that meets MEC requirements. Important: During the application process, upload proof of your Qualifying Life Event, such as a letter stating the end of coverage, to the insurance carrier.
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:
What is Minimum Essential Coverage (MEC)?: Learn more about MEC requirements and their importance in health insurance.
FAQs on QSEHRA Compliance: Explore additional resources on federal QSEHRA guidelines and compliance.
Common document rejection reasons and fixes
My document was rejected — but I'm not sure why
If neither the portal nor an email shows a specific reason, contact Customer Experience with your name, employer name, and the date you uploaded the document. They can identify the exact deficiency so you can correct it before resubmitting.
Common rejection reasons:
The document is not dated within the last 30 days — a prior-year invoice is not accepted even if the plan is still active.
The document does not show the monthly premium amount (for premium reimbursement).
The plan name, metal tier, or carrier name is missing or unclear.
The document type is not accepted — screenshots of payment history do not qualify as proof of coverage.
The file is in HEIC, TIFF, or another unsupported format — convert to PDF or JPEG before resubmitting.
The document is for a dependent or spouse and does not clearly indicate the HRA-eligible employee as a covered member.
I was covered on my spouse's employer plan — what document should I submit?
Submit your spouse's employer plan documentation showing:
The employee (your spouse) and you listed as a covered dependent.
The plan name and carrier.
The monthly premium your household pays — specifically the portion you contribute personally (out-of-pocket, not the portion paid pre-tax through your spouse's paycheck).
Note: if your spouse's employer pays the premium pre-tax through payroll deduction, your reimbursement may be taxable. Contact Customer Experience if you are unsure how this affects your claim.
I am on Medicare — what documents do I submit?
Acceptable Medicare proof of coverage documents include:
Your red, white, and blue Medicare card (for Part A / Part B).
An SSA letter confirming Medicare Part B premiums deducted from your Social Security benefit.
A monthly Medicare billing statement showing the premium amount.
A Medicare Advantage (Part C) enrollment confirmation or ID card.
Note: Medicare Part B by itself does not qualify as MEC — you need Part A + Part B together, or Part C (Medicare Advantage). Contact Customer Experience if you are unsure which parts of your coverage qualify.
My plan renews annually — do I need to resubmit proof of coverage every year?
Yes. At each plan year renewal, you must upload updated proof of coverage showing the new plan year dates and premium amount. Your prior-year documentation expires when your new plan year begins.
Your recurring premium reimbursement entry should also be updated if your premium amount changed at renewal — cancel the existing entry and submit a new one with the updated amount.