Under group health insurance, a certificate of coverage is issued to whom?

Under group health insurance, a certificate of coverage is issued to the employee. This certificate serves as a formal document that outlines the coverage provided by the group health plan. It includes important details such as the benefits, limitations, exclusions, and the conditions under which the coverage is provided.

Issuing the certificate to the employee ensures that they have direct access to information about their health insurance benefits, enabling them to understand what services are available to them and how to utilize their coverage effectively. This is essential for employees to be informed participants in their health care decisions.

While the employer also plays a significant role in the group health insurance arrangement, they typically receive a master policy, while individual employees are provided with the certificates. The insurance agent does not receive the certificate directly related to coverage for an employee, nor does the insurance company receive one for their own use in the same manner as the employee. Therefore, it is crucial that employees receive their certificates to understand their health insurance options and coverage details.