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  • Private Market Required to Provide Clear, Comparable Information on Health Plans

    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 changes significantly.

    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

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