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Certificate of Coverage (CoC)

What is a certificate of coverage (CoC)?

A certificate of coverage (CoC) is a contract that lists an individual’s health insurance coverage with their payor. The CoC details the health benefits the beneficiary and their dependents have under their plan.  

Details include exclusions and conditions. Exclusions are uncovered services, and conditions are actions needed to receive benefits. Conditions may include deductibles and copays

Individuals can usually receive a written copy of their CoC from their payor at no charge. 

Why are certificates of coverage (CoCs) important to healthcare?

Certificates of coverage are important to healthcare because they provide valuable information on the terms of health insurance plans to the involved parties. Individuals can reference this information in making informed medical care decisions. CoCs also contain information that individuals can use to appeal decisions made by payors.