Summary of Benefits and Coverage (SBC)

What’s a Summary of Benefits and Coverage?

Maybe you’ve heard the term, Summary of Benefits and Coverage — also called “SBC.” It’s often talked about when it comes to choosing health plans and learning about costs. That’s because it’s basically a document that outlines what’s covered — and not covered — under a health plan.

All health plan companies are required to provide an SBC for each of their different plans. When you’re making decisions about buying a plan or using your benefits, an SBC can be a useful tool to help you compare costs and understand coverage options.

Using an SBC to compare and shop for plans

The SBC was created to make it easier to compare and shop for health plans. What’s especially helpful is that every health plan has to use the same outline to show the costs and coverage for each of the plans they offer.

Because it’s all in the same format, it’s easier to make apples-to-apples comparisons when you’re deciding which plan is best for you. You can use the SBC to compare prices, benefits and other health plan options and features that might be important to you.

Here’s what a sample SBC looks like (pdf)

Finding the information you need

There’s a lot of information in an SBC. Even though it’s meant to make the information easier to understand, it can seem like a lot at first. Every SBC is created with four double-sided pages and 12-point type.

Here’s a step-by-step look at what information is in an SBC:

An overview of what’s covered
An explanation of what’s not covered and/or the limits on coverage
Information on costs you might have to pay — like deductibles, coinsurance and copayments
Coverage examples, including how coverage works in the case of a pregnancy or a minor injury
A reminder that the SBC is only a summary. To get all the details, you’ll want to look at complete health plan documents.
Information about where to go online to review and print copies of complete health plan documents
Where to find a list of network providers
Where to find prescription drug coverage information
Where to find a Glossary of Health Coverage and Medical Terms (also called a “Uniform Glossary”)
A contact number to call with questions
A statement on whether the plan meets minimum essential coverage (MEC) for the Affordable Care Act (ACA)
A statement that it meets minimum value (plan covers at least 60 percent of medical costs of benefits for a population on average)

Where to get an SBC

You can request a copy of an SBC anytime. To get one, contact us. When you already have a health plan, you’ll get an SBC automatically at certain times:

On the first day of open enrollment
When you renew your health plan
When changes happen within your health plan
When you make a change or are added to a health plan — for example if you get married, have a child, or experience another qualifying life event

Understanding an SBC

Even though an SBC is made to make it easier to understand health plan information, sometimes the terms in them can be confusing.

You can use the Glossary of Health Coverage and Medical Terms, also called a “Uniform Glossary” to get clear, simple answers about what terms mean.

It’s also possible to get an SBC in another language. Contact us or connect with customer service by calling the number on your health plan ID card to ask for a copy in the language you need.