Also commonly referred to as an SBC for short, a summary of benefits and coverage is a specific type of document that all health insurance companies are actually required to provide you under the ACA (also called the Affordable Care Act or Obamacare). This is true whether you're getting healthcare from a private health insurance company directly, through your employer, or via the marketplace in your state.
It can be a daunting thing to read, but the good news is that it does tend to follow a very rigid format regardless of which provider you're working with.
By understanding what this kind of document says, you'll have a much better idea of exactly what value you're getting in exchange for your premium every month.
Understanding Your Summary of Benefits and Coverage: An Overview
Consider the summary of benefits and coverage as something of an overview of the entirety of your plan: from the overall costs, to the benefits, to the covered healthcare services and more. Under the ACA, your SBC will go into more detail about any unique features that your plan offers. Think things like policy limits, exceptions to certain types of coverage, cost sharing rules, and more. This is true regardless of the plan types you're talking about, like HMO/PPO options, an EPO, a POS, or something else entirely.
If you have any supplementary coverage in addition to your standard medical coverage like dental or vision, this information will also be provided in the way of an overview on this document.
Because of the significant amount of industry jargon that usually accompanies a lot of these things, the good news is that companies will also provide a glossary that explains all of this to you in more detail. If you have any questions about what a particular term means or what it implies with regard to your coverage, consult the glossary first.
Typically, your SBC will be broken down into a few distinct categories. The first will involve your monthly premiums, which is the amount of money that you must pay each month to maintain coverage. You will also see your deductible, which is the amount that you need to meet before coverage kicks in.
When viewing your SBC electronically (as will be common), you'll also see links to important documents like a plan brochure and even a helpful provider directory. Finally, you will see a breakdown of that aforementioned supplemental coverage like dental. If child dental benefits are included, for example, they will be noted. Exclusions, like certain types of adult benefits, will also be outlined in this breakdown.
It is very important to review this document thoroughly before buying a health plan so you ensure it covers what you need, and you clearly understand your responsibilities and costs for items like prescriptions, surgeries, specialist visits, etc.
To learn additional information about how to effectively read your health insurance summary of benefits and coverage, and to find a health insurance plan that fits your needs, call us today! We will connect you with a licensed insurance agent in your area to find the options that most align with your needs.
