How do I find out why my proof of coverage was declined?
If you're wondering why your proof of coverage was marked as noncompliant, you'll first want to check your member portal, in the Health Insurance section, to find a note from our Compliance team explaining why it was declined. It will look like this:
What are common reasons why a proof of coverage is declined?
The most common reason a proof of coverage upload is declined is because the plan does not meet Minimum Essential Coverage (MEC) guidelines, or our team cannot tell whether the plan meets MEC.
Other reasons it may be declined:
Incomplete information: The document you uploaded does not show your name, a recent date, premium amount, or the plan name, and we may need additional information.
Outdated information: We require documents dated within 30 days for compliance checks. If you upload an ID card for a compliance check, it may be declined with a request for more updated information.
Incorrect information: For proof of coverage, we are looking for proof of your health insurance coverage. If you upload proof of your dental or vision insurance only, it will be declined as neither of those represents a qualified health insurance plan that meets MEC guidelines.
How does Take Command Health determine whether a plan is compliant?
The IRS has established guidelines for the type of insurance that is required for an employee to be able to participate in the QSEHRA. On top of that, the IRS has guidelines on the type of premiums that are reimbursable. It's our job at Take Command Health to ensure that your company remains compliant according to the IRS' guidelines.
For the most comprehensive overview, check out the Requirements section of our QSEHRA guide and/or our Reimbursement Guide.
To receive tax-free reimbursements through the QSEHRA, employees are required to have insurance that is considered Minimum Essential Coverage (MEC).
Here is a summary of how we review your coverage to confirm MEC, based on those IRS guidelines linked above, the ACA definition, and the healthcare.gov summary. Examples of plans that do not qualify are indemnity plans, critical illness, and short-term plans.
Your insurance company is familiar with this language, and they should be able to tell you if your plan is ACA compliant or not.
If you are not sure whether your plan qualifies, call your insurance company to ask. Or, their website may even clarify that it does or does not qualify. For example, United Healthcare specifies on their website that their fixed indemnity insurance plans are not ACA/MEC plans.
I saw what was missing and found another document to submit, how do I submit it?
You can re-submit another document to the compliance team by clicking "Edit" under the Health Insurance tab:
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