It’s Your Health Insurance: Before You Enroll – Take Control
You have new rights and protections when it comes to your health coverage. As of September 23, 2012 or soon after, most health insurance plans and issuers are required to give you a Summary of Benefits and Coverage - or SBC - under certain circumstances. The SBC offers a picture of the medical care the plan covers. This includes the covered health benefits, some of your costs, and information about your network of doctors and other providers.
The SBC also includes a new health plan comparison tool called Coverage Examples. The idea for the Coverage Examples came from the Nutrition Facts label – that rectangle on packages showing the food’s calories or grams of fats—we all use when choosing what foods are right for us.
The Coverage Examples show you what part of the cost of care a health plan will cover for a sample patient for two common medical situations – having a baby and managing type 2 diabetes. For example, it tells you what a typical co-pay might be like for a diabetes management drug, and total estimated patient costs for a normal delivery. View a sample of this comparison tool below:
View a sample SBC (PDF – 530 KB).
To make it easier for consumers to understand some of the common terms used in health insurance, the SBC includes a list (glossary) with definitions. All SBCs should look the same so that you can compare plans and find the best coverage for your needs.
The federal government took steps to make sure that the SBC is a trusted, reliable, impartial tool for consumers. Consumers, the federal government, insurance commissioners, and industry representatives worked together to develop the SBC.
How Do I Get Copies of the SBC?
Under the law, you may receive an SBC:
- When you shop for coverage
- When employers shop for coverage to offer their employees
- When you are choosing options among job-based plans
- If you or your family is shopping or using insurance in the individual market
- If you are an employer who gets coverage from an insurance issuer
- If you and your family are currently covered by an employer plan
Depending on your situation, your employer or insurance company must provide an SBC before you purchase or enroll in coverage, before you renew coverage, and when you request it.
If you get your insurance through your job, your employer will have a copy of your SBC; if you buy insurance outside of work, your insurance company will have your SBC.
In some parts of the country, you may have access to an SBC in Spanish, Chinese, Tagalog, or Navajo.
What Are the Benefits?
The SBC benefits consumers by:
- Helping you better understand your coverage and compare options
- Helping you find the best coverage for you and your family
- Helping employers find the best coverage for their businesses and their employees
- Reducing the difficulty of finding and comparing coverage information
- Encouraging health insurance issuers to compete on price, benefits, and quality
Where Can I Get More Information?
To learn more about the SBC and other consumer protections relating to health insurance, go to www.healthcare.gov/law/features/rights/sbc/index.html or read a fact sheet on increasing transparency and protecting consumers. Remember: Ask to See the S B C.
Last updated: September 23, 2012