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New Summary of Benefits and Coverage (SBC) provides a snapshot of your coverage

Standardized Nutrition Facts labels were introduced on packaged foods in the U.S. in the 1990s. In a similar fashion, the Department of Health and Human Services will soon launch a document called a Summary of Benefits and Coverage (SBC) to help consumers understand their health coverage.


A component of the Affordable Care Act, the SBC will offer you a snapshot of the medical and drug care your health plan covers. SBCs will look the same between health insurance carriers so you can easily compare plans.


The SBC contains only a partial description of the benefits, limitations, exclusions and other provisions of your health plan.  It is not a contract or policy. It is a general overview only and does not provide all the details of coverage. In the event there are discrepancies between the SBC and your Coverage Manual, Certificate, or Policy, the terms and conditions of your Coverage Manual, Certificate, or Policy will govern.


Key features of the SBC


1. Cost sharing. This feature includes the basic cost-sharing components of the plan, including deductible, copay, coinsurance and out-of-pocket limits.


2. Coverage Examples. A key component of the SBC is a new health plan comparison tool called Coverage Examples. This will show you what a health plan will cover for a sample patient, for two common medical situations – having a baby and managing type 2 diabetes. In addition, you will find the estimated costs for health care components including prescription drug costs, outpatient services, emergency medical care and hospital stays.


3. What’s covered and not covered. Here you will find a partial list of common services covered and not covered under your plan, such as alternative therapies, chiropractic care and infertility treatment. These are referred to as Excluded Services & Other Covered Services and include some of the limitations and exceptions that can be expected with the plan.


4. Glossary of terms. To make it easier for you to understand some of the common terms used in health insurance; including “deductible” and “copayment.” Definitions and terms are intended to be simple and concise.    


This article provides information of a general nature. None of the information contained herein is intended as legal advice or tax advice or opinion relative to specific matters, facts, situations or issues. Additional facts and information or future developments may affect the subjects addressed in this document. You should consult with a lawyer or tax adviser about your particular circumstances before acting on any of this information because it may not be applicable to you or your situation.  Any company or person noted herein is hypothetical and for illustrative purposes only. 


Related Information

Blue Cross and Blue Shield Association publications on health care reform issues:
»   12 Myths About Health Insurance pdf image
»   Health Care Spending by Major Payor pdf image
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