What’s on a Summary of Benefits and Coverage (SBC)?

Picking out a health insurance plan that’s best for you and your family is a big decision. And let’s face it, reading through plan details can be downright overwhelming. You want to make a good decision, but how do you keep all of the information straight? Good news, there’s something you can read that might help make your decision a little easier. It’s called a Summary of Benefits and Coverage (SBC).

An SBC is a document that summarizes how a health insurance plan will pay for covered health care services. It has the answers to questions you may be asking yourself such as, how much is the plan’s overall deductible? Or, what will my copay for a visit to the doctor be? Plus, an SBC is a standard, required document that the insurance company or your employer must provide. This means you can gather SBCs from all the plans you’re considering and make a true “apples-to-apples” comparison between plans.

An SBC is made up of many pages, but we break down some of its key features below.

1. The name or logo of the company you’re purchasing insurance from will be listed here, along with the name of the plan.

2. This section lets you know the date in which the plan’s coverage will be effective. It also lists if the plan is for an individual or family, as well as the type of plan.

3. In the Coverage Overview section, you’ll find a list of important questions and answers that relate to the copays, deductibles and out-of-pocket limits for the plan. You’ll learn what you can expect to pay out of your pocket before the plan starts to pay.

4. These boxes will be filled in with the information specific to the plan.

5. The Common Medical Events Chart section lists common medical services you might need and how much you can expect the plan to pay for those services. For example, if you know you’ll need annual lab work or if you’re considering pregnancy, this section tells you what you can expect to pay and if there are any limitations or exceptions for those services.

6. These boxes will be filled in with the information specific to the plan.

7. Near the end of every SBC is a section called Coverage Examples. It’s used to show how the plan would work in three different medical events. These events are the same on every SBC. The example costs aren’t real, but they will give you a breakdown of how the plan would pay for different items associated with those events.

8. These spaces will be filled in with example dollar amounts.

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