Summary of Benefits and Coverage (SBC)
Making it easier to understand your benefits
Within the next several months, you’ll be receiving a form from Wellmark called an SBC. It stands for Summary of Benefits and Coverage. Its purpose is to provide a new and simpler approach to helping you understand your benefits and coverage, making it easier for you to compare plan coverage and costs.
The SBC uses common terminology and a format that has been standardized among all health insurance companies. That way, it’s simpler for you to compare plans and make important decisions about the coverage you choose. This SBC document is being produced as part of the federal health care reform law.
You can expect to receive an SBC from Wellmark, or from your employer, at the following times:
- When you apply for coverage, or during your employer’s open enrollment
- Upon renewal
- When you change your plan
And if you ever want to get an SBC from us, we’ll be more than happy to provide one to you by simply calling us.
More information on SBCs will be provided in the next issue of Blue magazine.
Visit the Health Care Reform section at WeKnowReform.com for more information on SBCs.
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.
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