Understanding the Summary of Benefits and Coverage (SBC)

Understanding the Summary of Benefits and Coverage (SBC) Fast Facts for Assisters This Fact Sheet Provides Guidance to Help Assisters:i,ii  Interpret the Summary of Benefits & Coverage (SBC) for health plans  Assist consumers with using the SBC to compare health plan benefits Summary of Benefits & Coverage: Overview To help consumers compare the different features of health benefits and coverage, the Affordable Care Act generally requires all group health plans and health insurance companies to provide individuals a “summary of benefits and coverage” that “accurately describes the benefits and coverage under the plan.” The SBC is a snapshot of a health plan’s costs, benefits, covered health care services, and other features that are important to consumers. SBCs also explain health plans’ unique features like cost sharing rules and include significant limits and exceptions to coverage in easy-to- understand terms. Along with the SBC, group health plans and health insurance companies must also provide a Uniform Glossary to explain common medical and insurance-related terms. This fact sheet focuses on the SBC provided by health insurance companies that offer coverage through the Marketplaces. The sample SBC used below is for illustrative purposes only and is not intended to reflect any Marketplace plan option. As consumers compare qualified health plans (QHPs) offered through the Marketplaces, you can help them figure out some of the benefits offered in each plan by walking them through the SBC. What Assisters Need to Know About Locating the SBC Consumers may access the SBC within each health plan’s detailed view at HealthCare.gov. Refer to Exhibit 1 for an example of a health plan’s detailed view, which allows consumers to learn more about health plan options before they select one and enroll. CSG-201906