Understanding the Summary of Benefits and Coverage
The Summary of Benefits and Coverage (SBC) is simple and standardized comparison document required by the Patient Protection and Affordable Care Act (PPACA). All insurance plans are required to produce a Summary of Benefits and Coverage based on a uniform template and customized to reflect the plan’s unique terms.
If you need a paper copy, call 1-877-7-NYSHIP (1-877-769-7447) and select the Medical/Surgical Program.
Contents of the SBCs
The SBC is a standardized template and the cells cannot be altered, moved, or deleted by any plan. There are four major sections – Important Questions, Common Medical Events, Excluded Services & Other Covered Services and Coverage Examples. The Coverage Examples are:
- Having a Baby
- Managing Type II Diabetes
- Simple Fracture
These examples are based on presumptions of what services a person may receive over a year of each scenario. The numbers are industry based using government guidelines and do not reflect the actual cost of the scenario.
Terms defined in the Uniform Glossary
Some words on the SBC are shown in bold and underlined. These terms are defined in the Uniform Glossary, a non-customized companion document to the SBC. These definitions are intended to help improve consumer understanding and do not necessarily reflect your plan’s definition of the same term. Refer to your plan material for the definition used by your plan.
Summary of Benefits and Coverage
To see the SBCs for NYSHIP health insurance plans applicable to you, select your employment status (and union/bargaining unit, if applicable).
Already Enrolled?
View the Summary of Benefits and Coverage related to your specific plan