Which document outlines the terms of coverage in an employer-sponsored health plan?

The master contract is the document that outlines the terms of coverage in an employer-sponsored health plan. It serves as the foundational agreement between the employer and the insurance company, detailing all aspects of the health plan, including coverage specifics, benefits provided, eligibility requirements, and the obligations of both parties. This comprehensive agreement ensures clarity regarding what the plan covers and the responsibilities of the employer to provide these benefits to employees.

In the context of employer-sponsored health plans, the master contract is essential because it governs the overall relationship between the insured group (employees) and the insurer. It includes critical details such as enrollment procedures, the premium amounts, and the circumstances under which coverage may change.

While other documents such as the summary plan description provide an overview of the key features of the health plan and are designed to help employees understand their benefits, they are based on the provisions established in the master contract. The policyholder agreement and certificate of insurance serve different purposes and do not encapsulate the comprehensive terms of the coverage in the same way that the master contract does.