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FAQs for Plan Participants

What does SBC mean?
SBC is short for Summary of Benefits and Coverage. It is intended to help you understand your health coverage and compare health plans when shopping for coverage.

What is the Uniform Glossary?
The Uniform Glossary is a list of commonly used healthcare terms and their definitions that was designed for use with the SBC. Terms and definitions are provided by the federal government and may differ from those used in other plan documents describing your coverage.

What is the purpose of the SBC and Uniform Glossary?
The SBC and Uniform Glossary are meant to help you understand your healthcare coverage and common terms. SBCs must be provided by all insurance companies and group health plans in a standard format, and may only be different based on the specific benefits of each plan. This consistent format should help simplify comparing and shopping for health plans.

Why did I receive this document?
You received the SBC because the federal government requires all healthcare insurers and group health plan sponsors to provide it to plan participants at certain times beginning September 23, 2012.

How often will I get an SBC?
Your employer or plan sponsor is required to provide the SBC upon request and at various times, whether you have coverage through your employer or through a policy you buy yourself:

  • When you enroll in coverage
  • If your coverage changes after you enroll and it affects the information in the SBC, you’ll get a new one by the first day your changed coverage starts
  • When your coverage is renewed

What information is included in the SBC?
The SBC includes:

  • A summary of the services covered by the plan
  • A summary of the services not covered by the plan
  • The copays, coinsurance and deductibles required by the plan
  • Information about your rights to continue coverage
  • Information about your appeal rights
  • Examples of how the plan will pay for certain services

The SBC is not a substitute for a Summary Plan description because it is not a comprehensive representation of all the plan benefits and services.

What do the Coverage Examples on page 7 of the SBC show?
The federal government requires all insurance companies and group health plans to provide two examples of covered services under the plan. The two examples are having a baby and managing type 2 diabetes.

The examples are not intended to show your exact costs, because each person’s care will be different. Instead, the sample costs are based on national averages supplied by the Department of Health and Human Services. They are not specific to a health plan or certain geographic area.

These examples should help you compare coverage between plans. The “Patient Pays” box at the bottom of each example shows how each plan offers more or less coverage for these two conditions.

Will HRA or FSA information be included on my SBC?
No. Money from a health reimbursement account (HRA) or flexible spending account (FSA) that is used to pay for out-of-pocket expenses would not be included in the coverage examples shown on an SBC. You will see the following disclaimer:

"These numbers assume that the patient does not use an HRA or FSA. If you participate in an HRA or FSA and use it to pay for out-of-pocket expenses, then your costs may be lower. For more information about your HRA or FSA, please contact your employer group."

How can I request a paper copy of my SBC?
You can ask for a paper copy of your SBC at any time, free of charge. Contact your employer or plan sponsor to receive a copy.

Can I stop receiving the SBC?
No. Your plan administrator is required by law to provide you with the SBC.

How do I get a copy of the Uniform Glossary?
You can request a free paper copy of the Uniform Glossary at any time by calling your employer or plan sponsor. You can also print a copy of the Uniform Glossary link.