Substantiation Standard Checklist
Help users define proof requirements, independent verification, plan-term review, no self-attestation alone, and record retention.
Purpose
Help users define proof requirements, independent verification, plan-term review, no self-attestation alone, and record retention.
When to use
Use before launch, during reimbursement workflow review, when changing administrators, or when reimbursement evidence gaps appear.
Who should use this
Finance owner, reimbursement administrator, advisor, compliance reviewer, HR, or evidence-file owner.
Review boundary
Substantiation and reimbursement rules affect tax treatment, plan terms, and compliance. Route uncertain issues to qualified review.
Resource sections
Annual coverage substantiation
- Define what proves coverage for the year or plan period.
- Record source, owner, and retention location.
- Route uncertain proof standards to qualified review.
Ongoing substantiation
- Define when recurring, monthly, or claim-level substantiation is needed.
- Identify administrator and reviewer.
- Retain evidence of review.
Proof of coverage
- Identify acceptable proof of coverage categories.
- Avoid relying on self-attestation alone unless qualified review says it fits.
- Record source/version and evidence location.
Proof of payment
- Identify acceptable proof of premium or expense payment.
- Separate proof of coverage from proof of payment.
- Record correction path for incomplete proof.
Independent verification
- Define whether and how independent verification applies.
- Name the reviewer or administrator.
- Route employee-provided documents when facts are uncertain.
Reimbursement approval/denial path
- Define approval, denial, appeal, and correction paths.
- Connect denial notices to claims and appeals procedure.
- Retain decision evidence.
Correction process
- Define what happens when proof is missing, unclear, or later corrected.
- Name escalation owner.
- Retain resolution notes.
Record retention
- Record where reimbursement and substantiation records live.
- Respect privacy and sensitive-data boundaries.
- Connect records to compliance audit index.
Reviewer or owner
- Name routine owner, review owner, and escalation owner where needed.
- Document plan-term or tax review boundaries.
- Retain checklist export or print.
Evidence to retain
- Substantiation standard - Retain with the audit file, evidence map, or review record as applicable.
- Proof requirement notes - Retain with the audit file, evidence map, or review record as applicable.
- Reimbursement records - Retain with the audit file, evidence map, or review record as applicable.
- Denial/correction records - Retain with the audit file, evidence map, or review record as applicable.
- Reviewer note - Retain with the audit file, evidence map, or review record as applicable.
- Evidence location - Retain with the audit file, evidence map, or review record as applicable.
Evidence is not saved in this static version. Assign an owner, repeat the process consistently, review exceptions, explain the rationale, and retain copies in the employer file or local project record.
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No database records or server-side files are created. Use these browser-only actions to retain a local copy.
Substantiation and reimbursement rules affect tax treatment, plan terms, and compliance. Route uncertain issues to qualified review.