Exhibit 1: Health Plan Details with SBC What Assisters Need to Know When Reviewing the SBC with Consumers Assisters should help consumers understand that all SBCs consist of the following basic parts: Important Questions: Consumers can use this section to understand some of the health plan’s costs, including deductible amounts and out-of-pocket limits. This section also contains information on coverage for in-network and out-of-network providers. Common Medical Events: This section provides cost sharing information for certain common medical events (such as copayments and coinsurance amounts) and significant limitations or exclusions. Services described include a visit to a provider’s office, having an MRI or CAT scan, having a hospital stay, and prescription drug information. Excluded Services and Other Covered Services: Consumers can refer to this section to learn about certain services that are not covered by their health plan, as well as some additional services the plan does cover.
Understanding the Summary of Benefits and Coverage (SBC) Page 1 Page 3