Giving Consumers a Picture of Health Insurance Costs & Benefits

By Kathleen Sebelius, Secretary of Health and Human Services
Posted September 24, 2012

Thanks to the health care law, starting today, millions of consumers will have access to a new consumer-friendly summary to help them understand their health insurance and compare health coverage options. This new tool, called the Summary of Benefits and Coverage—or SBC—has a uniform format that shows you basic information about your health insurance plan and how much it costs. The SBC also includes a new comparison tool, called Coverage Examples, that shows you what your insurance would cover in two common medical situations—having a baby and managing type 2 diabetes.

Health insurance issuers and group health plans must also provide access to a glossary of common terms (PDF 139KB) used in health insurance, such as “copayment” and “deductible,” with easy-to-understand definitions. And—for the first time—consumers who want to take a deeper dive into a particular plan or policy will be able to review the full contract outlining the benefits and limitations—before they sign up for coverage

The SBC will help consumers make informed choices based on critical information. For example, the Coverage Examples concept is modeled on the Nutrition Facts label—that rectangle on packaged foods with calories and grams of fat—that we now rely on when trying to make healthy choices for ourselves and our families at the grocery store. 

Coverage Examples showing what your insurance would cover.

Starting today, consumers can review SBCs for many individual market plans which are posted on the Plan Finder , here on HealthCare.gov (Click on “Find Insurance Options”).  In addition, health plans and health insurance issuers must give you the SBC at certain times during the plan or policy year, including when you purchase coverage and when coverage renews.  Also, consumers can always get an SBC from a plan or issuer by requesting it.

The health insurance marketplace can be confusing for consumers.  The SBC will help explain benefits and costs in plain language and in a uniform and recognizable format so consumers can see how a particular plan works in terms they understand.  In addition, the SBC will not contain any “fine print” or insurance jargon. Instead, you’ll get the basic facts. And when we make the insurance marketplace more transparent and competitive, we empower consumers and help drive costs down.

Remember—Before you enroll, take control. The SBC can help you find a health insurance option that is best for you.

For a sample SBC, please visit this page (PDF 530KB).

For the SBC template, please visit this page (PDF 475 KB).