Under the Affordable Care Act, the Summary of Benefits and Coverage was created. This tool is intended to help you understand what is covered by your health plan or compare different health insurance plans directly.
A Summary of Benefits and Coverage can be interpreted in the following manner.
An overview of the health plan is located at the top of the SBC. There will be information about the insurance company, the plan, the dates of coverage, and the individuals covered (you, your spouse, you and your family).
In the section below the general plan information, you will find a section with important questions. There are answers to questions regarding your financial responsibility under the plan.
In this section, you will learn:
There is a list of common health insurance terms provided by the SBC. Co-payments, for instance, are fixed amounts you pay for covered health care services, usually when you receive them. “Coinsurance” is the portion of the service cost that you bear, calculated as a percentage of the allowed amount.
You will find the cost of certain medical services in this section. A copay is stated when you visit your primary care doctor, see a specialist, have x-rays or blood work, or have an MRI or CT scan. In addition, it will provide you with information about your out-of-pocket costs for generic, preferred brand, non-preferred brand, and specialty medications, and when you use a non-participating provider.
An exclusion list will be provided by the SBC. There are also covered services such as chiropractic care, acupuncture, bariatric surgery, weight loss programs, and hearing aids.
Health insurance plans are usually easier to understand when they include a Summary of Benefits and Coverage, though they can still be confusing. For assistance choosing a health insurance plan or understanding your coverage, contact our friendly agents.
