The Summary of Benefits and Coverages (SBC) outlines information about health plan benefits and coverage in simple terms. The SBC allows individuals to understand the terms of a health plan while providing the ability to easily compare different plans. Additionally, it will explain essential features of the plan or coverage, including the covered benefits, cost-sharing provisions, and coverage limitations and exceptions. SBCs will also include coverage examples that illustrate how the plan handles claims for specific scenarios and will be helpful for consumers to see how valuable the plan will be at times when they may need coverage.
Health insurance issuers will provide the SBC at the following times:
Note: This is the standard format for all SBCs up until April 1, 2017. Health plans and issuers are required to use the new SBC template beginning on the first day of the first open enrollment period that begins on or after April 1, 2017. For plans that do not use an annual open enrollment period, the new SBC template is required beginning on the first day of the first plan year that begins on or after April 1, 2017. For more information, visit this Department of Labor page.
Where to Find the Summary of Benefits and Coverage
Finding the Summary of Benefits and Coverage (SBC) in Zenefits is easy. Depending on whether an employee is enrolling for the first time or going through Open Enrollment, or if ... Learn more
SBC - Deductible, Out-of-Pocket Limits, Networks, and Referrals
The SBC explains the deductibles for individuals and families, annual out-of-pocket limits, whether a provider network is used, and if certain services require referrals. Rec... Learn more
SBC - Primary Care Doctor and Specialist Visits, Preventive Care, Tests
The SBC explains the coverage level for seeing primary care doctors and specialists, as well as what's covered under preventive care. This will also detail what the plan covers ... Learn more
SBC - Mental and Behavioral Health, Maternity, Rehabilitation, Special Needs Services
The SBC explains how the plan covers mental and behavioral health services, pre- and post-natal benefits, as well as the coverage for special needs services. This is the stan... Learn more
SBC - COBRA Continuation Rights, Appeals, Minimum Essential Coverage
The SBC explains an enrollee's right to continue coverage under COBRA, how to submit appeals or file a grievance for claims, and confirms whether or not Minimum Essential Cover... Learn more
The SBC gives two common examples of how the plan would pay for coverage: having a baby, and managing Type 2 Diabetes. This is the standard format for all SBCs up until April... Learn more
The SBC goes over some frequently asked questions about the Coverage Examples on the previous page This is the standard format for all SBCs up until April 1, 2017. Please refe... Learn more
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