Health insurance has become a critical need and can be considered an important investment on par with stocks and mutual funds. It is not only important for our health but also for our financial future. As such, it is important to know what an insurer has promised you through their plan and to hold them accountable in case these promises are not fulfilled. A document that can help you do all these things and more is a certificate of insurance (COI). Here’s everything you need to know about this key piece of insurance documentation.
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A certificate of insurance (COI) is a very important document that is issued by the health insurance company to the policyholder. It contains crucial details such as:
While COI provides a summary of the health insurance policy, it is not the actual policy itself. But it is a very crucial document on its own, and here are some of the purposes it serves:
The COI acts as proof of coverage agreed upon between the policyholder and the insurance company. It acts as proof that the policyholder and their dependents are indeed covered under a specific health insurance plan issued by the company. You may be asked to produce it by the hospitals when you are admitted for treatment and want to use your insurance plan to cover treatment costs.
Health insurance policy documents can be very extensive in nature and filled with legalese. While it is in your best interest to read and become familiar with the entire policy document, if you need a quick summary of what your insurer has promised you, then the COI will do that for you. It will give you a quick rundown of the coverage provided by the insurer, including the services excluded and included in your plan. You will also find details related to your co-pay and deductibles. You will find the process for claims and appeals in case your claim is rejected laid out in the COI.
In case you get into a dispute with your insurer, the COI serves as proof of the benefits that have been promised by the insurer to the policyholder, in addition to the policy document in its entirety.
When in need of a COI, you can contact your health insurance company for a copy of the same. It will usually be available through your insurer’s website and can be emailed to you as well. It should be made available to you within 48 hours of your request being acknowledged by the insurer. You may need to provide your policy number and any other details your insurer may ask for the COI to be issued. Once your request is accepted, the insurer will verify your details and ensure that your policy is active with no outstanding dues and then issue the COI. If you require a physical copy of the COI, put in a special request for the same with your insurer.
If you are employed, you are entitled to health insurance coverage from your employer in the form of a group health insurance plan. A COI can be issued to the employees, and it will contain all the benefits they will receive through the group insurance plan.
Once you receive the COI, verify if all the details given in the COI match those mentioned in your insurance policy document. If there is a mismatch, raise it with your insurance provider and get the details fixed to reflect your policy document. This will include:
Certificate of Insurance is an important piece of documentation you, as a policyholder, are entitled to from a health insurance company. It has many purposes, chief among which is proof that you are owed certain services and benefits from your insurer. It serves as an additional layer of protection for the policyholder.
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Reviewed by Dr. Harshita Dahiya 
Acko Technology & Services Private Limited
#36/5, Hustlehub One East, Somasandrapalya, 27th Main Rd, Sector 2, HSR Layout, Bengaluru, Karnataka 560102
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