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Summary of Benefits and Coverage

Understanding the Summary of Benefits and Coverage (SBC) Under the ACA

Under the Affordable Care Act (ACA), health insurers and self-funded employers must provide a uniform Summary of Benefits and Coverage (SBC) to individuals applying for or enrolling in health plans.

What Must Insurance Companies & Group Health Plans Provide?

A Short, Plain-Language SBC – A clear summary of what a plan covers, including benefits, costs, and limitations.

A Uniform Glossary – A standardized list of health coverage terms, helping you understand medical and insurance-related language.

Why Is This Important?

Easy Policy Comparisons – The SBC format is the same across all policies, allowing for “apples-to-apples” comparisons between plans.

Coverage Examples – The SBC includes real-life coverage examples, such as:

  • Diabetes Care

  • Childbirth & Maternity Costs

Where Can You Find the SBC?

📌 Health Insurance Marketplace – Every plan on the Marketplace includes an SBC. Look for a link on the policy page when enrolling.

📌 Your Insurance Provider – You can request an SBC copy from your insurance company or group health administrator at any time.

📌 During Enrollment & Renewals – Insurers must provide the SBC at key points, such as when you apply for or renew coverage.

📌 Uniform Glossary – If you need help understanding health coverage terms, ask for a copy of the Uniform Glossary.

Have Questions?

We’re here to help you navigate your health insurance options. Contact us today for free guidance in selecting the best policy for you!

This Medicare information section is here to educate you about your insurance options and provide you with the resources you need to help you select the right plan for your unique needs.

If there’s anything you need or if you have any questions, please feel free to contact us. We are here to help.