Summary of Benefits and Coverage
What is a Summary of Benefits and Coverage?
The Summary of Benefits and Coverage – also referred to as an SBC – is a federally-required consumer document that provides basic health plan coverage information in a standardized format.
Will I receive a Summary of Benefits and Coverage?
Members covered under any of the following policy types will have access to an SBC:
- Commercial insured
- Early retirees
What plans are exempt from the requirement to provide a Summary of Benefits and Coverage?
Group and Individual Medicare and Medicaid plans are not required to provide the SBC.
Why is Providence Health Plan and Kaiser Permanente creating the Summary of Benefits and Coverage?
The document is required under the Patient Protection and Affordable Care Act (i.e., federal health care reform legislation).
What plan information does a Summary of Benefits and Coverage contain?
It contains basic benefit information related to coverage which may include medical, pharmacy, vision, chiropractic and alternative care benefits.
What is the purpose of the Summary of Benefits and Coverage?
The purpose of the document is to present information in a standard format, thereby enabling consumers to compare various plan options in an “apples to apples” manner across plans and/or health insurance companies.
How is a Summary of Benefits and Coverage different from a benefit summary?
The SBC is a federally mandated document that reflects basic plan information. The format, used by all carriers, allows consumers to compare benefits of various plan options, particularly across multiple insurance carriers when choosing health plan coverage.
Does the Summary of Benefits and Coverage replace the benefit summaries currently made available?
No; Providence Health Plan will continue to generate and utilize benefit summaries as we have in the past.
Why might I receive more than one Summary of Benefits and Coverage?
At renewal, the SBC provided is based on the information available just prior to the open enrollment period. If an employer group chooses another plan prior to the effective date, a new updated SBC will be provided.
Where can I get the Summary of Benefits and Coverage?
The Summary of Benefits and Coverage (SBC) for the Clackamas County group health plans are available on the Clackamas County Human Resources Internet page under Benefit Providers.
What is a uniform glossary?
“Uniform glossary” is a term often used to refer to the Glossary of Health Coverage and Medical Terms – a consumer education tool developed by the federal government in association with health care reform and the federally mandated SBC.
Where can members access the uniform glossary?
The glossary is available on the Department of Labor website, a link to which is posted on the Providence Health Plan website and also included in the SBC. A hard copy of the uniform glossary will be provided upon request in accordance with federal requirements.
Who should I contact if I have questions regarding the Summary of Benefits and Coverage or the uniform glossary?
If you have questions regarding the Summary of Benefits and Coverage document, please contact the applicable provider. Additional information is also available at HealthCare.gov.
Providence Health Plan Customer Service
503-574-7500 or 800-878-4445 or visit their website.
Kaiser Permanente Customer Service
503-813-2000 or 1-800-813-2000 or visit their website.
Contact our Benefits team at 503-655-8550, 7 a.m. to 6 p.m Monday through Thursday.