Summaries of Benefits and Coverage (SBC) will now accompany all health plans.
Mandated under the Patient Protection and Affordable Care Act (PPACA), the SBC is similar to the Summary Plan Description (SPD) that employees receive, explaining the details of the health plan. The SBC is not intended to replace the SPD or any other of the current health plan documents; its purpose is to provide simple, uniform information to help participants make decisions about their coverage options. Items listed in the SBC include:
- Uniform definitions of insurance and medical terms
- Description of coverage, including exceptions and limitations
- Deductible, copayment, and coinsurance information
- Examples of how coverage will work in common benefits scenarios, such as pregnancy
- Internet addresses where applicable for a copy of the SBC, prescription drug coverage, and provider networks
- Nextep and our benefit partners have made arrangements to comply with this mandate.
Benefit providers and brokers are preparing and providing these documents. At appropriate times, such as annual enrollment, employee onboarding, HIPAA events, or upon employee request, benefits brokers will supply the SBC documents in accordance with the law.
