Resolving Non-Compliance of Proof of Coverage
When a submission for proof of health coverage is marked as non-compliant, it typically means the documentation submitted does not meet the required standards or criteria. This article will walk you through the most common reasons for non-compliance and provide step-by-step guidance on correcting your status.
Overview of Compliance Requirements
To maintain compliance and qualify for Individual Coverage Health Reimbursement Arrangement (ICHRA) reimbursements, employees must ensure their health insurance documentation:
Shows proof of enrollment in an individual health insurance plan (e.g., a Marketplace plan, private insurer policies). Group health plans are not eligible.
Includes the individual’s name as a covered member.
Displays a plan name and insurer.
Clearly lists the effective date of the plan.
Is dated within the last 30 days to demonstrate active coverage.
Failure to meet these criteria may result in a "non-compliant" status.
Common Reasons for Non-Compliance
Missing or Incorrect Documentation Details
Missing Basic Information: - Your submitted documentation might lack critical details such as your full name, plan name, insurer, or premium amount. Re-submit with all required information.
Effective Date Issues: - Proof of coverage may not include an acceptable effective date or display an out-of-date record. Ensure the uploaded document is dated within the last 30 days.
Document Type Ineligibility: - Group health plans, like employer-sponsored plans, do not qualify. Ensure you are enrolled in and submit proof for an eligible individual health insurance plan.
Missing Information for Specific Plans (e.g., TRICARE): - If you have a TRICARE plan, your proof must include a clear, recent effective date to meet compliance.
Documentation Assigned to the Wrong Year
If your coverage document was mistakenly uploaded for the wrong year (e.g., 2026 instead of 2025), the information may be flagged as non-compliant. To correct this:
Log in to your Take Command member portal.
Navigate to the Health Insurance section.
Click Edit next to the relevant year.
Re-upload your document for the correct year, ensuring it: - Shows your name, insurer, and plan. - Is dated within 30 days.
This update will allow the compliance team to review the correct documentation.
How to Resolve a Declined Submission
If your submission has been marked non-compliant, follow these steps:
Review your notification to determine the specific reason for the non-compliance.
Collect the necessary documentation that addresses the issue, including: - A current proof of coverage document, such as your insurance bill. - A document dated no more than 30 days ago.
Log in to your member portal and upload the corrected document.
Example: If your proof of coverage doesn’t show your name, submit an insurance bill or record that explicitly includes it.
FAQs About Non-Compliance
Why was my proof of coverage marked non-compliant for missing details?
Common reasons include missing individual names, unclear effective dates, or lack of evidence for active coverage.
Can group health plans be reimbursed through ICHRA?
No, only individual health insurance plans qualify for ICHRA.
What if my document doesn’t show my plan’s effective date?
Make sure to submit documents where this information is prominently displayed, such as a health insurance bill or contract.
By ensuring accuracy and providing all necessary details, you can avoid common non-compliance scenarios. For ongoing issues, consult the portal’s help section or contact support for further assistance.