Summary of Benefits and Coverage
Making it easier to understand your health plan.
You have new rights and protections when it comes to your health coverage. Starting on Sept. 23, 2012, or soon after, most health insurance plans and issuers will be required to provide consumers with a document called a Summary of Benefits and Coverage (SBC).
The SBC (sample below), a component of the Affordable Care Act, is designed to help you better understand and compare your coverage options by outlining the medical care and prescription drug benefits your health plan covers, including covered health benefits, some of your costs, limitations and exceptions, and information about your network providers.
A Uniform Glossary of Benefits (sample below) is also available to you. With simple and concise terms, the glossary makes it easier for you to understand some of the common terms used in health insurance; including “deductible” and “copayment.”
Please Note: The definitions in this glossary were developed as part of the Affordable Care Act to meet the requirements of the SBC document provision, and may be different from the terms and definitions in your plan. Some of these terms also might not have exactly the same meaning when used in your policy or plan, and in any such case, the policy or plan governs.
Wellmark is not providing any legal advice with regard to compliance with the requirements of the Affordable Care Act ("ACA").Regulations and guidance on specific provisions of the ACA have been and will continue to be provided by the U.S. Department of Health and Human Services ("HHS") and/or other agencies. The information provided reflects Wellmark's understanding of the most current information and is subject to change without further notice. Please note that plan benefits, rates, renewal rate adjustments, and rating impact calculations are subject to change and may be revised during a plan’s rating period based on guidance and regulations issued by HHS or other agencies. Wellmark makes no representation as to the impact of plan changes on a plan's grandfathered status or interpretation or implementation of any other provisions of ACA. Any questions about Wellmark's approach to the ACA may be referred to your Wellmark account representative. Wellmark will not determine whether coverage is discriminatory or otherwise in violation of Internal Revenue Code Section 105(h). Wellmark also will not provide any testing for compliance with Internal Revenue Code Section 105(h). Wellmark will not be held liable for any penalties or other losses resulting from any employer offering coverage in violation of section 105(h). Wellmark will not determine whether any change in an Employer Administered Funding Arrangement affects a health plan’s grandfathered health plan status under ACA or otherwise complies with ACA. Wellmark will not be held liable for any penalties or other losses resulting from any Employer Administered Funding Arrangement. For purposes of this paragraph, an “Employer Administered Funding Arrangement” is an arrangement administered by an employer in which the employer contributes toward the member’s share of benefit costs (such as the member’s deductible, coinsurance, or copayments) in the absence of which the member would be financially responsible. An Employer Administered Funding Arrangement does not include the employer’s contribution to health insurance premiums or rates.