Summary of Benefits and Coverage
As part of the healthcare reform law, the government developed a new health plan information document called the Summary of Benefits and Coverage (SBC). The SBC will help you understand and compare different medical plan options that your school district may offer. It provides an overview of each plan in a standard format and is written in easy-to-understand language. Links to all applicable MUST SBCs are provided after the following explanation.
The SBC includes three parts:
- Benefits and coverage information
- Coverage examples
- A link to the Uniform Glossary
Benefits and coverage information
This section includes a chart that lists the main features of the medical plan option(s). It answers questions about the coverage levels of the plan options. It also provides specific information about coverage for different services, such as office visits, prescription drugs and emergency room services.
The coverage examples show how the plan might cover medical care for two specific scenarios. The examples show what the plan would pay and what the patient would pay based on a common set of assumptions. It is important to note that these are examples only. They should not be used to estimate your actual costs under the MUST plan.
The SBC explains how to access or request a glossary with definitions for common health insurance and medical terms, such as copayment and deductible. There may be differences between terms found in the Uniform Glossary and those in your health plan documents. In these instances, you should go by the terms in your health plan document.
If you have questions about the SBC or would like a copy sent to you at no charge, please contact MUST customer service at 1-800-845-7283. Additional information about the SBC can also be found at the HealthCare.gov website.