Guide To Reading Your Summary Of Benefits And Coverage

​The Affordable Healthcare Act mandated the creation of the Summary of Benefits and Coverage (SBC). It was created as a standardized tool to assist you in better understanding what your health insurance plan covers or comparing other health insurance policies directly. The following is a step-by-step instruction to reading a Summary of Advantages and Coverage.

Information About the General Plan
A portion with general information on the health plan is included at the top of the SBC. It should consist of the insurance company's name, the plan's name, the coverage dates, the persons insured (you, your spouse, and your family), and the policy type (HMO or PPO).

Commonly Asked Questions
It provides answers to queries concerning your financial obligations under the plan. For example, this section will tell you:

• The amount of the deductible for an individual or a family.
• Whether or not particular services, like prescription medication coverage, have deductibles.
• What is the maximum out-of-pocket expense for both participating and non-participating providers?
• Is there an overall yearly coverage limit?
• Where can you get a list of providers that are part of the plan?
• Whether or not you require a referral to see an expert.

Terms
The SBC offers a glossary of popular health insurance words. For example, "co-payments" are described as predetermined monetary amounts paid for insured health care services, generally at the time of service delivery. "Coinsurance" refers to your portion of the expenses of a covered service, determined as a proportion of the service's allowable amount.

Examples of Coverage
The Overview of Benefits and Coverage should include examples of coverage for Type 2 diabetes management and having a baby. It should calculate the total amount owing to providers, the amount paid by the plan, and the amount you will pay for each of these two medical incidents. 

It may also include the yearly expenditures of each service related to these occurrences, such as prescription drugs, office visits and procedures, and laboratory testing.

In Summary
If you want more clarification, your insurer should give a glossary of words relevant to your SBC. All phrases highlighted in the SBC should be included in this glossary. However, the labor department gives a typical sample below. Always consult your insurance provider's paperwork for the most detailed and up-to-date information.

At Arnold, Bruce & Doerfler Insurance, we aim to provide comprehensive insurance policies that make your life easier. We want to help you get the insurance that fits your needs. You can get more information about our products and services by calling our agency at (503) 222-1951. Get your free quote today by CLICKING HERE. Coverage discussed in this article is not guaranteed. Please contact our agents today to ensure that your needs are being met and learn more about your policy. We are happy to help!