Under the Affordable Care Act (ACA)
insurance companies and employers now are required to provide consumers in the private health
insurance market with a brief summary of what a health insurance policy or
employer plan covers, called a Summary of Benefits and Coverage (SBC).
Additionally, consumers will have access to a uniform glossary that defines
insurance and medical terms in standard, consumer-friendly terms.
These tools also will help employers find the best coverage for their
business and employees.
SBC includes a new comparison tool that helps consumers compare coverage
options by showing a standardized sample of what each health plan will cover
for 2 common medical situations. The comparison tool is modeled on the
nutrition facts label required for packaged foods.
SBC will include information about the covered health benefits,
out-of-pocket costs, and the network of providers. The glossary defines terms
commonly used in the health insurance market, such as "deductible"
and "copay," using clear language.
Starting this fall, consumers will receive SBC free of charge and in writing
from their insurance companies or employers. This information can be requested
at any time, but it will also be made available when shopping for, enrolling
in, or renewing coverage. It also will be provided whenever information in SBC
SBC now is available for consumers in the individual health insurance
market. For enrollees in group health plans enrolling during an open enrollment
period, it will be available during the next open enrollment period that
started on or after September 23, 2012. For enrollees who enroll outside of an
open enrollment period, it will be available at the start of the next plan year
that began on or after September 23, 2012.
The Center for Consumer Information
and Insurance Oversight provides examples of SBC,
an SBC template, and the uniform glossary.
Additional information for consumers
is available at healthcare.gov.