What is a Certificate of Coverage?

A certificate of coverage is a legal document that details your health insurance policy terms, including covered benefits, exclusions, cost-sharing requirements, and member rights and responsibilities. This document serves as your official proof of insurance and explains how your plan works, what services are covered, and what you'll pay for healthcare services.

Why certificates of coverage matter

• Defines your benefits: Clearly outlines what medical services your insurance will and won't cover
• Explains your costs: Details your deductibles, copayments, coinsurance, and out-of-pocket maximums
• Protects your rights: Specifies appeal procedures and your legal protections as a plan member

How Solace can help

A Solace advocate can help you interpret complex insurance terminology in your certificate of coverage, identify important coverage details relevant to your healthcare needs, and use this document to resolve coverage disputes or appeal claim denials. Advocates can also ensure you understand your rights and responsibilities under the plan.