What does SBC mean?
SBC is short for Summary of Benefits and Coverage. It is intended to help you understand your health coverage and compare health plans when shopping for coverage.
What is the Uniform Glossary?
The Uniform Glossary is a list of commonly used healthcare terms and their definitions that was designed for use with the SBC. Terms and definitions may differ from those used in other plan documents describing your coverage. Uniform Glossary terms are defined by the federal government, so there may be some differences in how private insurance companies define similar terms.
What is the purpose of the SBC and Uniform Glossary?
The SBC and Uniform Glossary are meant to help you understand your healthcare coverage and common healthcare terms. SBCs must be provided by all insurance companies and group health plans in a standard format and may only be different based on the specific benefits of each plan. This consistent format will help simplify comparing and shopping for health plans.
Why did I receive this document?
You received the SBC because the federal government requires all healthcare insurers and group health plan sponsors to provide it to plan participants at certain times beginning September 23, 2012.
How often will I get an SBC?
Insurers and group health plan sponsors are required to provide the SBC upon request and at the various times outlined below, whether you have coverage through your employer or through a policy you buy yourself:
- When you enroll in coverage
- If your coverage changes after you enroll and it affects the information in the SBC, you’ll get a new one by the first day your changed coverage starts
- When your coverage is renewed
What information is included in the SBC?
The SBC includes:
- A summary of the services covered by the plan
- A summary of the services not covered by the plan
- The copays and/or deductibles required by the plan
- Information about your rights to continue coverage
- Information about your appeal rights
- Examples of how the plan will pay for certain services
What do the Coverage Examples on page 7 of the SBC show?
The federal government requires all insurance companies and group health plans to provide two examples of services covered under the plan. The two examples are having a baby and managing type 2 diabetes.
The examples are not intended to show your exact costs, because each person’s care will be different. Instead, the sample costs are based on national averages supplied by the Department of Health and Human Services. They are not specific to a certain geographic area or health plan.
These examples should help you compare coverage between plans. The “Patient Pays” box at the bottom of each example shows how each plan offers more or less coverage for these two conditions.
Will HRA or FSA information be included on my SBC?
No. Money from a health reimbursement account (HRA) or flexible spending account (FSA) that is used to pay for out-of-pocket expenses would not be included in the coverage examples shown on an SBC. You will see the following disclaimer:
“These numbers assume that the patient does not use an HRA or FSA. If you participate in an HRA or FSA and use it to pay for out-of-pocket expenses, then your costs may be lower. For more information about your HRA or FSA, please contact your employer group.”
How can I request a paper copy of my SBC?
You can ask for a paper copy of your SBC at any time, free of charge. Just call our Customer Care Specialists at the toll-free number on your ID card or on the SBC. You can also print a copy of your SBC after logging in to your My Health Plan account on MedMutual.com.
How can I receive my SBC electronically?
You can request an electronic copy of your SBC by calling our Customer Care Specialists at the toll-free number on your ID card or on the SBC. You can request all future SBCs be provided to you electronically by visiting MedMutual.com and logging in to My Health Plan.
- Select the My Health Plan link at the top of the page.
- Click My Profile > Communication Preferences.
- Then click Edit next to Summary of Benefits and Coverage to change your SBC setting to Paperless SBCs.
Your SBC is also available to view in your My Health Plan account.
Can I stop receiving the SBC?
No. We are required by law to provide you with the SBC. However, we encourage you to sign up for electronic delivery of your SBC, which reduces mail and paper clutter, helping you to stay organized. To sign up for electronic delivery at any time, please log on to My Health Plan on MedMutual.com and follow the instructions above.
How do I get a copy of the Uniform Glossary?
You can request a free paper copy of the Uniform Glossary at any time by calling our Customer Care Specialists at the toll-free number on your ID card or on the SBC. You can also print one from this electronic copy of the Uniform Glossary.
Certificate books describe what is covered by your plan. View all of our 2019 certificate books here.