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More funding for health insurance for children

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summary of benefits

Soon you'll see a new document from your health insurance company. It's called a Summary of Benefits and Coverage, or SBC. This document gives you an easy-to-understand breakdown of your coverage. Health care reform requires insurance companies to have this ready for members. And every company has to follow the same format, so you can easily compare plans side-by-side. If you have a health care plan, you'll get a copy.

What's in the Summary of Benefits and Coverage?

Each SBC follows the same format, so they're easy to compare from company to company, or plan to plan. The SBC:

  • Tells you what's covered, what's not covered and the estimated costs you'll pay for care. It's not an entire list - it's only a summary. For more details, see your certificate of coverage.
  • Makes it easier to choose the best coverage for you and your family.
  • Is available either as a hard copy or online, if your health insurance company posts it.

Compares costs of two common health experiences:

  • Having a baby with a normal delivery
  • Living with well-controlled Type 2 diabetes

Learn about the different parts of the SBC

How it impacts you

If you have a health insurance plan, or will get one soon, this change matters. Because insurance companies have to give you one, and because they have to follow the same format, you can compare your choices like never before.

Can I find an in-network doctor in the SBC?

No, the Summary of Benefits and Coverage doesn't list out doctors in the network. To find an in-network doctor, call your health insurance company. If you have one of our health plans, you can also use our find a doctor tool.

Is my premium amount in my SBC?

No, your premium amount (what you pay for coverage) is not in the SBC. Keep in mind, the SBC doesn't take the place of other information about your health plan, such as a certificate of coverage or benefit summary. To find your premium amount, it's best to look at your certificate of coverage – or to call your insurance company.

When do I get a copy of my SBC?

Each health insurance company sends it at a different time. If you have coverage through an employer, you'll receive it from them around enrollment time with your other benefit materials. If you have a plan or are shopping for a plan, you may get it:

If you'd rather not wait, you can always ask for one. Call customer service to find out when you can get your copy.

Can I get my SBC online?

It depends on your company. Many companies are posting SBCs on their intranets.

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Useful Tools

  • If it’s not an emergency (and you can’t get to your regular doctor) - there are other options for fast, more affordable care.

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