Summary of Benefits and Coverage

What is the Summary of Benefits and Coverage (SBC) document? 

Specific to plans offered under the Affordable Care Act (ACA), the Summary of Benefits and Coverage (SBC) is a required document based on a model template issued by Centers for Medicare & Medicaid Services (CMS) to outline in plain language information about each health plan’s benefits and coverage. This document serves as a standardized health plan comparison tool with coverage examples similar to the Nutrition Facts label required for packaged goods. These examples illustrate how the insurer would cover care for common benefits scenarios. The SBC is not to be confused with the Summary of Benefits document, which is required for Medicare Advantage and Part D plans, and other plans subject to the Medicare Communications and Marketing guidelines. For support and additional information, explore our solutions for Health Plans Regulated Communications.