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The New SBC: A Conversation Starter

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The process of reading through your health insurance plan is about as delightful as reading the assembly directions for an IKEA dresser.

The print is small, the terms are confusing, and the covered services are difficult to decipher.

As of Sept. 23, 2012, all of that is scheduled to change. On this date, as part of the Affordable Care Act (ACA), all health insurance companies will be required to provide consumers with a Summary of Benefits and Coverage (SBC).

An SBC: What Is It?

SBCs will be clear and concise documents that spell out all of your benefits and coverage in easy to understand language.

The SBC will also contain “coverage examples” modeled after the Nutrition Facts labels that appear on packaged food.

Coverage examples will illustrate, for comparison purposes, just how much of the health care service a health insurance plan would cover for a sample patient. The terms of the individual plan will be applied to two common medical scenarios – having a baby and managing type 2 diabetes.

More scenarios are expected to be added as coverage examples later on, once consumers begin providing feedback.

SBCs: An Opportunity, Not a Chore

Brokers and health insurers can use the SBC requirements as a way to reach out to their clients and start a conversation about their current benefits.

Any type of outreach is a good way to find out who is unhappy or over-subscribed to coverage.

This could potentially lead to a change in health plans and is an opportunity to discuss other insurance products that may benefit the client.

Outreach could also help consumers realize they may not be utilizing a health plan to its fullest potential.

And, a combination of the SBC and outreach acts as a great reminder about clients’ and members’ plan benefits.


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