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A trusted independent health insurance guide since 1994.
What is a certificate of insurance?
A certificate of insurance is a document that defines the coverage provided by the insurance carrier to an insured person or business. Certificates of insurance are issued for many types of coverage: health insurance, disability insurance, life insurance, auto liability insurance, workers compensation, etc.
Specific to health insurance, a certificate of insurance is an explanation of how the plan works including a detailed description of the medical benefits covered by the insurance plan. Issuing insurance companies create certificates and provide them to the insured entity. If you are covered through an employer, you may need to contact your Human Resources department or call the insurance company to request a copy.
Certificates of insurance provide a wealth of information, such as benefit coverage and exclusions, benefit limitations, pre-authorization requirements, provider networks, cost-sharing requirements (such as copayments, coinsurance and deductibles), appeals process requirements, patient rights, privacy/confidentiality practices, and information on how to contact the plan if you have questions or need customer service. As with most contracts and legal documents, a certificate of insurance typically includes a definitions section for terms used throughout the certificate.
I didn’t get a certificate of insurance. Do different health plans use a different name for it?
A certificate of (health) insurance might also be called a certificate of coverage, summary plan description (SPD), evidence of coverage, or a contract.
What is an insurance rider?
A rider is a document that amends a certificate of coverage. It can be an addition or deletion of the coverage defined in the baseline certificate. According to healthcare.gov, exclusionary riders (ones that exclude benefits) have not been allowed in health insurance policies since 2014.