Topic:

Proof of Insurance and Employee Health Benefits

December 4, 2023
Proof of Insurance and Employee Health Benefits

Proof of insurance is documentation that shows that an individual is insured for auto, homeowner’s, life, medical, dental or other types of insurance.

In the context of employment and human resources, proof of insurance typically refers to a physical or digital health insurance card. Employees can also provide proof with a certificate of coverage—sometimes called a certificate of insurance, evidence of coverage, summary plan description or, simply, "contract.” A certificate of coverage is a document that provides detailed descriptions of the medical benefits the health insurance policy provides to the insured party and any dependents.

Insurers sometimes provide insurance cards. You can generally access your digital health insurance card by logging onto your insurance company’s secure patient portal or by downloading the card into a secure app on your phone. A certificate of coverage can be obtained by requesting one from the insurer.

An insurance ID card typically contains the policy number, plan number and/or a member ID number, as well as the policy effective dates.

Why is it important to have proof of insurance?

In some situations, proof of insurance is legally required. In others, having the proof readily accessible when you need it helps to resolve issues more efficiently.

For example, many states require car owners to carry proof of auto insurance. Police may demand to see it in the event of a traffic stop, and it's important to have should an accident occur.

Proof of life insurance helps survivors when a loved one dies. Proof of disability insurance can prevent delays in coverage and help ensure proper billing.

Where, when and why having proof of health-related insurance is critical

You may have several types of health-related insurance, such as medical, dental, vision, and long-term care. If so, carry or safely store your cards or other proof of insurance for each of your plans.

You may need to show your proof of insurance to receive healthcare services, ensure proper billing, and keep records.

For example, you may be asked to provide proof of health insurance to make an appointment with a health care provider. If you have a medical emergency, hospitals and emergency rooms are required to treat you even if you can’t prove you are insured. However, proof of insurance will likely prevent them from hitting you with medical bills for the full cost of the treatment. Trying to straighten that out after the fact could be a major hassle. Even worse, if they deem that your situation is not life-threatening or seriously impairing a bodily function, the hospital or ER could turn you away if you cannot prove you are insured.

Proof of insurance will help make sure you are quickly and appropriately covered or compensated for health-related services, prescriptions, medical devices or equipment. It will help ensure correct recordkeeping and filing, including proper recording of deductibles. It can also reduce delays in disability insurance coverage.

Proof of health insurance for tax and legal purposes

You may receive one or more of these forms early in the year that can help you prepare your income tax returns:

  • Form 1095-A, for people who had coverage through the Health Insurance Marketplace (sometimes called “the exchange”—this is ACA/Obamacare insurance)
  • Form 1095-B, for people who had health care coverage not reported on Form 1095-A or 1095-C
  • Form 1095-C, for employees who were covered by employer-sponsored health insurance, where the employers were applicable large employers (had 50 or more full-time or full-time-equivalent employees)

You can receive the forms on paper or, if you consent, electronically. These forms are for your information and to keep for your records. Don’t attach them to your tax return. The IRS receives the information on the forms directly from the Marketplace, coverage providers, or employers.

In the past, these forms were needed to prove that people met the individual shared responsibility provision (also called the individual mandate) of the Affordable Care Act. At the time, people had to prove they had health insurance, or else they would have to pay a tax penalty. That requirement was repealed, and the penalty was dropped as of 2019. However, some states penalize people who don’t have health insurance.

Where should you keep your proof of health insurance?

Store your proof of health insurance in a safe place if you are not carrying it with you. It probably does not have your Social Security number on it, but it does contain other sensitive data. Don’t leave it lying around where someone could steal your information.

Important tips:

  • Make sure your personal and contact info (name, address, phone number, email, etc.) are up-to-date with the insurance carrier.
  • Keep backup copies in a secure place.
  • Make sure that someone else (family member, travel buddy, first responders, etc.) can find and access your proof of insurance in the event of an emergency where you are unconscious or otherwise unable to present the information.

Get help with HR questions

What should you do if you’ve never received proof of insurance or if you no longer have it? If your health insurance plan is provided by your employer, contact your HR department or whoever is responsible in your company for administering benefits. You could also contact the insurance company directly to obtain proof.

If you own or manage a small or medium-sized business or work in HR, contact TriNet to learn how we can help you worry less about things like proof of insurance. You can depend on TriNet to steer your benefits compliance and administration. Our experts will navigate the requirements for ACA, COBRA, disability and state filings, while you focus on your core business.

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