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When shopping for a health insurance plan on a Marketplace, you may have come across a link to a document titled “Summary of Benefits and Coverage” (SBC) within the health plan details. If you’ve ever clicked on an SBC, you know how overwhelming and confusing it can seem! There’s a lot of information to unpack! Understanding how to read this document can help you choose the best health plan for your needs.

What an SBC is and where to find it

An SBC is a snapshot of a health plan’s costs, benefits, covered health care services, and other features that may be important to you. Essentially, this document is meant to help you understand what your plan covers and what you’ll need to pay when utilizing care services. All insurance companies are required by law to provide this document, and all SBCs outline the same basic information.

If you’re shopping for a health plan through, or a trusted partner, such as W3LL, the site will give you access to each plan’s SBC to help you determine if the plan meets your needs.

Summary of Benefit Coverage. Table "Oscar Plan Details".

In general, you can view/will receive an SBC when:

    • you’re shopping for a plan
    • you’ve enrolled in a new health plan
    • changes were made to your plan between when you enrolled and when your coverage started
    • changes were made to your plan on renewing your coverage – or sometime during the coverage period
    • you request them from your insurance company

The purpose of an SBC Summary of Benefits and Coverage

SBCs can help you figure out what plan is best for you when shopping for health insurance. It’s common for people to breeze through the document without fully reading or understanding every aspect of it. Not knowing all the details of your plan may cause you to end up with surprise health care bills! Becoming an SBC superstar will help you know what to expect if, for example, you experience an emergency or need a specific medical treatment.

You should also use SBCs to help you understand what best suits your specific health needs. For example, if you’re pregnant or planning to become pregnant, look closely at the “If you are pregnant” section of the document. Here you’ll find information related to prenatal and postnatal care, as well as the delivery of your newborn. It will also give you details that can help guide your care decisions – like what it will cost to visit an in-network vs. an out-of-network doctor.

Summary of Benefit Coverage. Table "What you will pay".

Now, let’s walk through an actual SBC

While seemingly overwhelming, an SBC outlines what you’re getting when you purchase a specific plan. Below, see a sample SBC with key terms and plan information called out.

Summary of Benefit Coverage. Table "Coverage Overview".
Summary of Benefit Coverage. Table "Copayments".
Summary of Benefit Coverage. Table "Limitations".

Summary of Benefit Coverage. Table "Services insurance will not pay for".

What do these words mean?

Now that you understand how to access and review an SBC, you’re probably still wondering what many of these words mean. Many electronic SBCs will include links to definitions. If you want to be well-versed before opening and reviewing an SBC, we suggest you take a look at our glossary of common health insurance terms. Our glossary includes definitions of common words listed in SBCs. With a little effort, you’ll be an expert in no time!

Ready to select a plan that’s perfect for you? Get started now with W3LL!

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