The Center for Consumer Information & Insurance Oversight
Summary of Benefits and Coverage (SBC) and Uniform Glossary
As of September 23, 2012 or soon after, health insurance issuers and group health plans are required to provide you with an easy-to-understand summary about a health plan’s benefits and coverage. The new regulation is designed to help you better understand and evaluate your health insurance choices.
The new forms include:
- A short, plain language Summary of Benefits and Coverage, or SBC
- A uniform glossary of terms commonly used in health insurance coverage, such as "deductible" and "copayment"
All insurance companies and group health plans must use the same standard SBC form to help you compare health plans. The SBC form also includes details, called “coverage examples,” which are comparison tools that allow you to see what the plan would generally cover in two common medical situations. You have the right to receive the SBC when shopping for or enrolling in coverage or if you request a copy from your issuer or group health plan. You may also request a copy of the glossary of terms from your health insurance company or group health plan.
What This Means for You
It’s not easy for consumers to know what they are buying when shopping for insurance. The new rules are a joint effort among the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury. The SBC is designed after the Nutrition Facts label required for packaged foods which helps you make healthy and informed decisions about your diet. The SBC’s standardized and easy to understand information about health plan benefits and coverage allows you to more easily make “apples to apples” comparisons among your insurance options. The measure brings more openness to the insurance marketplace for the more than 180 million Americans with private health coverage.
Some Important Details
- This provision applies to all health plans, whether you get coverage through your employer or purchase it yourself, beginning September 23, 2012.
- All health plans must provide an SBC to shoppers and enrollees at important points in the enrollment process, such as upon application and at renewal.
- The coverage examples give a general sense of how a plan would cover the normal delivery of a baby, and services to help a person control type 2 diabetes.
- If you don’t speak English, you may be entitled to receive the SBC and uniform glossary in your native language upon request.
For More Information
- November 5, 2019 FAQ: Quality Rating Information Bulletin’s (Quality Bulletin’s) Display Guidelines for Direct Enrollment (DE) Entities
- November 1, 2019 Enhanced Direct Enrollment Approved Partners (Updated)
- September 11, 2019 FAQ: Enhanced Direct Enrollment Participation Requirements for Non-Issuer of a Primary EDE Entity Environment
- August 15, 2019 Quality Rating Information Bulletin for Plan Year 2020 Health Insurance Exchanges Quality Rating System (QRS) for Plan Year (PY) 2019: Results at a Glance
- April 18, 2019 CMS-9926-F: Final HHS Notice of Benefit and Payment Parameters for 2020 Final 2020 Letter to Issuers on Federally-facilitated Exchanges Key Dates for Calendar Year 2019: QHP Certification in the FFEs; Rate Review; Risk Adjustment
- April 4, 2019 Guidance on Unified Rate Review Timeline: Timing of Submission of Rate Filing Justifications for the 2019 Filing Year for Single Risk Pool Coverage Effective on or after January 1, 2020
- March 19, 2019 2020 Final Actuarial Value Calculator 2020 Final Actuarial Value Calculator Methodology
- March 6, 2019 CMS-9921-NC: Request for Information Regarding the Sale of Individual Health Insurance Coverage Across State Lines Through Health Care Choice Compacts
- February 28, 2019 Section 1332 Pass-through Funding Tools and Resources