Your client’s Summary of Benefits and Coverage (SBC) is an important document designed to provide vital information about their health insurance. Unfortunately, it is also one of the least-read documents for most of your customers. However, it is something that you and your clients should take the time to understand.
What Is Included in a Summary of Benefits and Coverage?
An insurance company’s SBC clearly outlines important information about an insured’s coverage, including:
- Plan Name
- Plan Type (PPO/HMO)
- Coverage Period
- Deductible(s)
- Copayment(s)
- Coinsurance
- Covered Medical Benefits
- Cost If Using an In-Network Provider
- Cost If Using an Out-of-Network Provider
- Covered Prescription Drug Benefits
An SBC can be particularly helpful if you or your clients want to compare plans. That’s because SBCs have to follow a uniform format, which allows for apples-to-apples comparisons.
An SBC includes real-world scenarios for common situations like having a baby or managing diabetes.
Because an SBC provides detailed information about exclusions, limitations, and network rules, it can often help your clients avoid surprise medical bills.
How to Read an SBC: What to Review With Your Clients
When you’re reviewing an SBC with your client, you’ll want to highlight important points like costs, including deductibles, copayments, coinsurance, and out-of-pocket limits. You will also want to be sure your clients understand how their choice of an in-network or out-of-network provider can impact their costs.
Equally important – or some would say, even more important – are the health plan’s excluded services as well as “other covered services.” Discuss coverage examples and what your client can expect when seeking care.
9 Questions to Ask Clients When Reviewing an SBC
- Is your current health or dental plan meeting your health care needs?
- Are you planning (or is your doctor recommending) any upcoming treatment, surgical procedure, or test?
- If so, have you considered your potential costs related to that care?
- Are you now pregnant – or are you planning to become pregnant? What about your dependents?
- Are your preferred doctors and specialists in-network? Will they be if you change plans?
- Will your prescriptions be covered in the same way if you move to a different health plan?
- If you’re considering a plan change, will your deductibles and copays remain the same?
- Would a move to a High-Deductible Health Plan be a good move?
- If you move to a HDHP, do/will you have access to a Health Savings Account?
The Bottom Line: Why Every Client Should Read Their SBC
An SBC is a useful snapshot of a health plan’s benefits, covered services, and other features important to your clients – and their wallets. An SBC explains each plan’s unique features including cost-sharing, coverage limitations, and exceptions in easy-to-understand terms Also available is a companion Uniform Glossary that explains common medical and insurance-related terms.
Where Can Brokers Find Carrier SBCs?
Word & Brown makes it easy for you to view PDFs for the plans marketed by our carrier partners. Our Carrier Pages includes links to a variety of carrier Summaries of Benefits & Coverage. Visit the W&B website, select California or Nevada, search for your preferred carrier, and click on “Full Carrier Details.” Under “Guides & Resources,” you’ll find links to SBCs, Provider & Rx Search information, and the carrier’s Small Group Enrollment Kit (if available).
Our team is here to make quoting, presenting, and enrolling groups easier. Don’t hesitate to reach out to your W&B rep if you have questions.
