Sample Completed SBC: Standard Format (DOCX) (HHS, Labor, Treasury)
Guidance for the disclosure requirements under section 2715 of the Public Health Service Act to help consumers better understand their health coverage, as well as compare coverage options by providing applicable entities an example of how an SBC template applicable on or after Jan 1, 2021 may be completed for a hypothetical plan or policy.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: February 03, 2020
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.