Here’s a potentially good change under the PPACA to inform insureds about their coverage, the SBC. I say potentially, because there are some weaknesses associated with the document, and the ever-present inclusion of “flexibility” means that as consumers, we’ll have to see how it actually works for us.
The SBC, (Summary of Benefits and Coverage) includes a Uniform Glossary, to better help us understand what we’re reading. While most plans will have an SBC, it’s important to know how you can find out about your plan. You can still call for details about your plan, but you can also request an SBC. The SBC will be online and will be available in hard copy, allowing for mailing time.
There are many helpful items that will be covered, including descriptions of cost-sharing, and what you’ll be required to pay out-of-pocket.
But there are some warnings to consider. The SBC is NOT your policy, it’s a summary of a policy compared to other policy alternatives, rather than your actual health insurance policy. Your policy is the document that will govern, so the SBC is only that, a summary. Instead of misinformation, which might happen, more realistically there will be omitted information, such as incomplete lists of exclusions.
If you have questions, call your plan, pin them down and request a copy of your policy and where the subject matter is covered within that policy. The SBC also typically will not have PREMIUM information, which means that it’s you’ll have to look in a separate place for that information.
The question arises whether we’ll bother reading the comparisons. They will likely be helpful in organizing your thoughts and function as a starting point for choosing your insurance policy.
Obviously, costs are very important and while the SBC will provide you with information about out-of-pocket costs, you’ll have to add in your share of premium costs. If you have specific medical needs, you’ll want to look more closely at those provisions and before choosing, call the plan and ask questions about it and get a copy of the policy and a location where you can find information about that medical need.
The purpose of the SBC is to provide a way for us to compare different plans. Of course, health insurance companies looking to sell their plans are always less clear on what they don’t cover, and the SBC leaves plenty of room for incomplete information on that front. However, the SBC is a tool that should work for consumers, thereby providing us with some power over our health insurance.
You can research this more by searching Department of the Treasury, Department of Health and Human Services or Department of Labor, Summary of Benefits and Coverage and Uniform Glossary.
Note, this is NOT a direct money saver for consumers, actually the contrary since as you’ll read, a large portion of the governmental consideration has to do with the costs of creating SBCs, distributing them, maintaining them for companies. What this is the creation of a document, the SBC that’s supposed to bring some uniformity and increased availability to consumers of documents having to do with their health insurance coverage.
