Plain Language Benefits Information

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.

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