Starting September 23, 2012, health insurance issuers and group health plans will be required to provide eligible participants with an easy-to-understand summary about a health plan’s benefits and coverage. The new regulation is intended to help individuals better understand their health insurance options.

Overview

The new forms include:

• A short, plain language Summary of Benefits and Coverage, or SBC
• A uniform glossary of terms commonly used in health insurance coverage, such as "deductible" and "copayment"

All insurance companies and group health plans must use the same standard SBC form to help you compare health plans. The SBC form also includes details, called “coverage examples,” which are comparison tools that allow you to see what the plan would generally cover in two common medical situations. You have the right to receive the SBC when shopping for or enrolling in coverage or if you request a copy from your issuer or group health plan. You may also request a copy of the glossary of terms from your health insurance company or group health plan.

What the Summary of Benefits and Coverage (SBC) Means for Individuals

The SBC is designed after the Nutrition Facts label required for packaged foods which helps you make healthy and informed decisions about your diet. The SBC’s standardized and easy to understand information about health plan benefits and coverage allows you to more easily make “apples to apples” comparisions among your insurance options. The measure brings more openness to the insurance marketplace for the more than 180 million Americans with private health coverage. 

 What the Summary of Benefits and Coverage (SBC) Means for Group Health Plans

This provision applies to all health plans, whether offered through an employer or purchased directly from an insurance company, beginning September 23, 2012.  All health plans must provide an SBC to eligible participants at important points in the enrollment process, such as upon initial enrollment and annual renewal.  If a participant does not speak English, he or she may be entitled to receive the SBC and uniform glossary in his or her native language upon request. 

For More Information

• View a sample SBC (http://cciio.cms.gov/resources/files/sbc-sample.pdf).
• Fact Sheet: Increasing Transparency, Protecting Consumers (http://www.healthcare.gov/news/factsheets/2012/02/increasing-transparency02162012a.html).

Source: http://www.healthcare.gov/law/features/rights/sbc/index.html