A Summary of Benefits and Coverage, often abbreviated to SBC, is a consumer-facing document outlining the benefits, coverage, and costs of an Affordable Care Act-compliant health plan. This snapshot clarifies the structure of your health plan without having to go through the lengthy and complex documents from your insurance provider.

While an SBC is designed to make things easier, many people find it confusing — and that’s where we can help. Below, this supplemental insurance provider in Dyer, Indiana is going to help you navigate the specifics of these documents.

The Purpose of an SBC

An SBC is a vital document given to you when you enroll in a new health plan and when making changes to the policy during the coverage period, before renewing, or before the coverage starts. The SBC helps you choose the best plan for your needs and compare multiple policies and their features. Many people don’t pay attention to the details of an SBC. But understanding the coverage only helps you keep realistic expectations. Here is how you can read the Summary of Benefits and Coverage to pick the best plan possible:

General Information

Every Summary of Benefits contains the name of the insurance provider, name of the plan, service costs, and FAQs. It outlines the coverage date, individuals covered, and plan type.

Important Questions

Right after the general details, you can find a list of questions answering your financial obligations under the plan. This section of the document mentions the deductibles, out-of-pocket limit, annual coverage cap, network of providers, and referral information.

Common Medical Events

Here, you can understand how to prepare for the uncertainties. The section takes you through the ways your plan will utilize the different costs. Visitation charges, diagnostics tests, procedures, etc., are all outlined in detail. You can also find the difference in the expenses on using an outside network provider, as well as any restrictions or exemptions to services (like using a chiropractor or mental health doctor). If you have a medical condition requiring prescription medication, your supplemental insurance provider in Dyer, Indiana will advise you to pay special attention to this section.

Exclusions

Your SBC might not contain all of the exclusions on your plan. It will most likely enlist the most asked exclusions, such as long-term care, dental and vision services, cosmetic surgery, etc. But to get a comprehensive list, you must read through the detailed documents of your plan as provided by the insurer. If you need help obtaining this information, your supplemental insurance provider in Dyer, Indiana can assist you.

Rights & Appeals

If you read the details under the exclusions, you will better understand your plan from the coverage and financial viewpoint. The last section reminds you of your privileges as a consumer and gives information on filing an appeal whenever needed.

Takeaway

All SBCs outline the essential information (i.e., the benefits and coverage) of your health insurance policy in a concise manner. However, many people still have a difficult time understanding the details. The wording and format can vary slightly, and the details can seem ambiguous.

Our supplemental insurance providers in Dyer, Indiana, have done their best to help you understand the basics of reading your SBC. We hope this information enables you to feel empowered and knowledgeable when comparing available health services, going through your current SBC, and understanding how different aspects can impact you financially. Without a doubt, understanding your health plan is the way forward to becoming an informed consumer. 

Looking for a Supplemental Insurance Provider in Dyer, Indiana?

Do you have any questions about your SBC document that were not addressed above? If so, and if you would like to speak with the top-rated supplemental insurance provider in Dyer, Indiana, the professionals at Senior Care Insurance Services would be happy to help you. Contact us today at (219) 736-7800 to schedule a consultation.