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Summary of Benefits and Coverage

Under the Affordable Care Act, health insurers and self-funded employers must provide a uniform Summary of Benefits and Coverage (SBC) to people who apply for and enroll in health policies.

Insurance companies and group health coverage must provide you with:

  • A short, plain-language Summary of Benefits and Coverage (SBC)
  • A Uniform Glossary of terms used in health coverage and medical care

This information allows you to make “apples-to-apples” comparisons when you’re looking at different coverage.

All individual and group health policies must use the same standard form to help you compare policies. The SBC also includes details, called coverage examples, which allow you to see what the policy would cover in two common medical situations: diabetes care and childbirth.

You can ask for a copy from your insurance company or group health administrator at any time. All health policies must provide the SBC to you at important points in the enrollment process, like when you apply for or renew your policy. You can also ask for a copy of the Uniform Glossary to help you understand words used in health coverage and medical care.