What is an SBC?

A Summary of Benefits and Coverage (SBC) is a document that summarizes the key features of a health plan, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions.

An SBC helps consumers:

  1. Better understand the coverage they have, and 
  2. Compare different coverage options. 

Under the Affordable Care Act (ACA), insurers and group health plans are required to provide participants with an SBC. The document has a standard format to provide consistent, plain language information about health plan benefits and coverage. Participants receive the summary when enrolling in coverage, at each new plan year, and within seven business days of requesting a copy from their health insurance issuer or group health plan.

If your employer is a Lumity client, SBCs are also available in your company's Digital Benefits Guide (Resources > Plan Documents).

Summary of Benefits and Coverage Examples

All SBCs provide the same two examples to show how the health plan would pay for coverage: 

  1. Having a baby, and
  2. Managing Type 2 Diabetes

Here's an Example SBC (.pdf) posted by the Centers for Medicare & Medicaid Services (CMS).

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