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Summary of Benefits and Coverage

Under the Affordable Care Act, health insurers and self-funded employers must provide a uniform Summary of Benefits and Coverage (SBC) to people who apply for and enroll in health plans. These plan documents must include a:

  • Four-page overview of plan benefits, cost sharing, and limitations
  • Required set of examples of how the plan works
  • Phone number and internet address for obtaining copies of plan documents
  • Standard glossary of medical and insurance terms

They must explain: when a new SBC must be provided, and how to access electronic versions

  • Issuing responsibilities for plans including more than 1 insurer and 3rd party vendor

U.S.-issued expatriate plans are exempt from the requirement to provide SBCs.

There is a new SBC template for plan years beginning on or after January 1, 2021. The major change is the elimination of information about the penalty for not having Minimum Essential Coverage.