What is a Summary of Benefits and Why Should I Read It?
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This is a 4 page, double sided (8 pages) at-a-glance view of how your health insurance plan works and how it compares to other plans. It contains coverage facts, and much more. It must follow a standardized format so all insurance companies’ insurance plan details are in the same place, making the comparison easier.
The idea behind the Summary of Benefits (SBC) is that you can easily understand how your plan works and compare it to other plans quickly, side by side. There will be some examples of how the plan works in certain circumstances on the last page. Our take here at Nevada Insurance Enrollment on this Summary of Benefits, is that it helps you understand how your plan works, but, truly it’s still difficult to really understand how your plan works even looking at the SBC. Our licensed agents can break down the insurance jargon for you and put it into normal everyday language.
The SBC is different than an insurance policy, which is called an Agreement of Coverage (AOC). The AOC (sometimes referred to as a COC, Certificate of Coverage) is a much larger (can be 70+ or more pages), that defines all the policy coverages and exclusions in your plan. Much different than the double sided 4 page Summary of Benefits. The AOC tends to spell things out more thoroughly to really get an understanding of how your plan works and what is really covered.
The SBC will not help you find doctors. It will not give you the pricing for the insurance plan. It will not tell you want is excluded in your plan. You can ask for a copy of both the SBC when you shop for a plan, and the AOC after you’ve enrolled into a plan.