If your Proof of Coverage (POC) or medical expense was declined, it usually means something was missing or didn’t meet requirements.
👉 The good news: most issues are simple and quick to fix.
We’ll walk you through the most common reasons and what to do next.
🧾 Part 1: Proof of Coverage (POC)
Your POC confirms you have an active, eligible health plan.
It needs to be approved before reimbursements can begin.
🔍 What We Check First
✅ 1. Required Information
Make sure your document includes:
Your name
Insurance provider and plan name
Your monthly premium (if you’re requesting reimbursement)
A current date (within 30 days)
Backdated coverage dates (if you’re submitting past premiums)
💡 A monthly bill or benefits summary usually works best here.
⚠️ 2. Tax Credits Showing (ICHRA Only)
This one comes up often with Marketplace plans.
If you're on an ICHRA, you can’t receive premium tax credits (APTC/subsidies).
If they show on your document → your POC will be declined.
👉 What to do:
Reach out to the Marketplace and have the tax credits removed, then resubmit.
⚠️ 3. Plan Type Isn’t Eligible
Not every plan works with an HRA, and this depends on your plan type.
Quick rule of thumb:
✅ Individual plans, Medicare, and student plans → usually eligible
❌ Short-term, group plans, or supplemental-only plans → usually not
If you're not sure, you're not alone—this is one of the most common questions we get.
📋 Full Plan Eligibility Details
ICHRA–eligible plans include:
Individual major medical plans (on or off the Marketplace)
Medicare Part A and Part B, or Part C (Medicare Advantage)
Student health insurance
Catastrophic Marketplace plans (under age 30)
ICHRA non-compliant plans include:
Short-term plans
Group plans of any kind (including employer-sponsored plans)
COBRA
Medicaid
TRICARE
Indemnity, hospital-only, accident, or cancer plans
Health sharing ministry plans
Plans that require a separate MEC add-on
QSEHRA–eligible plans include:
Individual plans
Medicare Part A or Part C
A spouse’s group plan or individual plan
Student health insurance
Health sharing or short-term plans (only if they include MEC and your employer allows it)
COBRA (only if your employer allows group plan reimbursement)
Medicaid
QSEHRA non-compliant plans include:
Short-term or sharing plans without MEC
Indemnity, hospital-only, accident, or cancer plans
⚠️ 4. Missing MEC (QSEHRA Only)
If you're enrolled in a QSEHRA, your plan must meet Minimum Essential Coverage (MEC).
If that’s not shown on your documents, we won’t be able to approve it yet.
⚠️ 5. Medicare Information Incomplete
ICHRA: Must show Part A + B, or Part C
QSEHRA: Must show Part A or Part C
A Medicare card or Social Security statement usually works.
⚠️ 6. File Upload Issues
Sometimes it’s as simple as the file itself.
Make sure your upload is:
Clear and easy to read
Under 10 MB
PDF, PNG, or JPEG
💡 Screenshots often work great if a document won’t upload properly.
🔄 How to Fix It
If your POC is declined, we’ll send you an email explaining why.
HRA Hub (ICHRA)
Log in
Click “I already have a plan” (or Recurring Premium)
Upload your updated document
Submit for review
Take Command (QSEHRA)
Log in
Click on 'Add Monthly Premium' directly from your dashboard
Upload a new document
Click Create Recurring Expense
💡 Quick tip: Most POC issues come down to missing details or outdated dates—check those first before resubmitting.
💊 Part 2: Medical Expenses
If your plan includes medical expense reimbursement, you can submit eligible out-of-pocket costs.
Each submission is reviewed to make sure it meets IRS guidelines.
🔍 What We Look For
✅ 1. Complete Receipt Details
Your receipt should show:
What you purchased or the service you received
The amount you paid
Date of service or purchase
Provider or store name
Patient name (when available)
❌ Credit card receipts alone won’t work—itemized detail is needed.
⚠️ 2. Duplicate Submission
If the same expense is submitted twice, the duplicate will be declined.
⚠️ 3. Expense Happened Too Early
The expense must occur after:
Your HRA start date
Your eligibility date
Your approved coverage start date
⚠️ 4. Submission Deadline Passed
Expenses must be submitted within:
90 days after the plan year ends, OR
90 days after your termination date
⚠️ 5. Expense Isn’t Eligible
Only IRS-approved medical expenses qualify.
Common examples that aren’t eligible:
Cosmetic procedures
Teeth whitening
Membership or subscription fees
Marriage counseling
⚠️ 6. Letter of Medical Necessity (LMN) Required
Some items need a doctor’s note.
Common examples:
Supplements (some exceptions apply)
Massage therapy
Weight-loss programs
👉 Your LMN must include:
Diagnosis
Treatment
Start and end dates
Provider signature
👉 And it needs to be updated each plan year.
⚠️ 7. No Active Coverage
You’ll need an approved POC on file first before submitting expenses.
⚠️ 8. Dependent Not Covered
If you’re submitting for a dependent, they must be covered under an eligible plan on the date of service.
⚠️ 9. File Upload Issue
If we can’t read the document, we can’t approve it.
👉 Try uploading a clearer version (PDF, PNG, JPEG under 10 MB)
🔄 How to Fix It
We’ll email you with the reason if something is declined.
HRA Hub (ICHRA)
Go to Benefits → Medical Expenses
Click Submit Medical Expense
Upload corrected documents
Take Command (QSEHRA)
Go to your Dashboard
Click Add Medical Expense
Resubmit with updated info
💡 Quick tip: Most medical expense declines are due to missing receipt details—double-check before resubmitting.
🤝 Still Need Help?
If you’re not sure what’s missing, reach out to Support—we’re happy to walk through it with you.