Summary of Benefits and Coverage
What is it?Under the health care reform law, the Patient Protection and Affordable Care Act of 2010 (PPACA), all issuers of health insurance are required to provide consumers with clear, consistent and comparable information about their health plan benefits and coverage — a Summary of Benefits and Coverage (SBC).
What does an SBC look like?The SBC is like a nutritional label for a health insurance plan. The eight-page form displays information about a health plan in a simple question-and-answer format. It answers questions like:
- What is the overall deductible?
- Is there an out-of-pocket limit on my expenses?
- Does this plan use a network of providers?
- Are there services this plan does not cover?
If you need clarification on what certain terms mean, there is a uniform glossary of terms commonly used in health insurance coverage.
How can I get an SBC?To generate an SBC select your state from the drop-down box below. Then select the appropriate plan, deductible and coinsurance levels.
NOTE: At this time, SBC’s are only available for our currently marketed plans. If your health insurance plan (plan name, coinsurance level, deductible) doesn’t appear in the drop-down menu below, your plan’s SBC is not available yet. Members in health insurance plans that aren’t currently marketed will receive an SBC before September 23, 2014.
Policyholders with effective dates of 12/31/13 and prior, click the link on the left.
Shoppers and policyholders with effective dates of 01/01/14 and after, click the link on the right.