What is the Difference Between a Policyholder and a Subscriber in Insurance?

When it comes to insurance terminology, the terms “policyholder” and “subscriber” are often used interchangeably. However, there are some key differences between the two that are important to understand.

What is a Policyholder?

A policyholder is the person who owns an insurance policy. They are the individual who purchased the policy directly from the insurance company or whose employer provides it as an employee benefit.

Some key attributes of a policyholder:

• Name listed on the insurance policy
• Responsible for paying premiums
• Has control over the policy (can change beneficiaries, cancel policy, etc.)
• Receives reimbursements and benefits

The policyholder is not necessarily the person being insured. For example, a parent could purchase a life insurance policy for a child. The parent would be the policyholder, while the child is the insured.

Types of insurance policies that have a policyholder:

• Life insurance
• Auto insurance
• Homeowners insurance
• Renters insurance
• Health insurance
• Disability insurance

What is a Subscriber?

A subscriber has a relationship to the insurance policy but is not the main owner. The subscriber is enrolled on the plan and their name may appear on insurance cards, but they do not have the same legal rights as the policyholder.

Some key attributes of a subscriber:

• Enrolled in an insurance plan
• May be partially or fully responsible for premium payments
• Receives benefits and coverage through the plan
• Does not directly control the policy

For employer-sponsored health insurance, the company is typically the policyholder while employees are subscribers. The subscriber uses the plan but the employer maintains legal ownership.

Other examples:

• A child is a subscriber on a parent’s health plan
• A spouse is a subscriber on their partner’s auto policy

The main difference is the policyholder has legal rights and responsibilities for the policy that the subscriber does not.

Comparing Policyholders vs. Subscribers

When Does the Terminology Matter?

In most day-to-day situations, there is little difference between being a policyholder or a subscriber. Both can use insurance coverage in the same way by going to the doctor, filing claims, and getting reimbursed.

However, in certain cases, the legal distinction is important:

Making Changes to the Policy

The policyholder has the authority to modify a policy in ways such as:

• Adding or removing dependents
• Updating contact information
• Changing beneficiaries
• Adjusting coverage levels
• Canceling a policy

A subscriber cannot directly make changes. Instead, they would need to go through the policyholder to request adjustments.

Resolving Claim Disputes

If an insurance claim is denied and the subscriber wants to appeal, the appeal will likely need to come from the policyholder. The insurance company only has a legal relationship with the policyholder.

Tax Reporting

At tax time, the IRS paperwork goes to the policyholder. Forms like 1095-B and 1095-C for health insurance are sent to the policyholder.

Sharing Private Information

Insurance companies take privacy laws very seriously. Customer service representatives will only discuss policy details with the policyholder unless there is written consent authorizing the release of information.

How to Determine Who Is the Policyholder

If you are unsure whether you are the policyholder or a subscriber, there are a few easy ways to find out:

• Check insurance cards – The policyholder’s name is usually listed first. Additional insured individuals are listed below as subscribers.

• Look for premium bills – The person receiving and paying the insurance premium bills is most likely the policyholder.

• Call customer service – An insurance company representative can tell you if you are the policyholder on record. You may need to verify your identity first.

• Review employer benefits – For workplace policies, the employer is often the policyholder. Employees and their families are subscribers.

• See if you can make changes – Try to modify the policy online or by calling the insurance company. If you can make changes, you are likely the policyholder.

Policyholder vs. Other Insurance Terminology

Policyholder and subscriber are two common insurance terms, but they are not the only ones you may come across. Here are definitions of other key insurance roles:

• Insured – The individual(s) covered and eligible to receive benefits from an insurance policy. This can be the policyholder or subscribers.

• Beneficiary – Individual(s) entitled to receive death benefits from a life insurance policy.

• Claimant – Person who files a claim for reimbursement from the insurance company. This is typically an insured or subscriber.

• Premium Payor – The person responsible for making premium payments. Typically the policyholder but could also be a third-party.

Conclusion

While policyholder and subscriber are sometimes used interchangeably, there are important legal distinctions between the two insurance terms. The policyholder is the owner of the contract with the insurer, while the subscriber is enrolled on the policy.

Knowing who the policyholder is can be critical when modifying a policy, resolving claim issues, handling privacy concerns, and more. However, for basic insurance coverage like going to the doctor or dentist, both play similar roles in using benefits and filing claims.