Easy-to-read document helps you understand your benefits.
You’ll receive a Summary of Benefits and Coverage (SBC) with your enrollment materials this year.
As part of the health care reform law, the government established a new health plan information document called the Summary of Benefits and Coverage (SBC). The SBC will help you understand and compare different medical plan options. It provides an overview of each medical plan in a standard format and is written in easy-to-understand language.
The Summary of Benefits and Coverage includes three parts:
- Benefits and coverage information
- Coverage examples
- A link to a Uniform Glossary
Benefits and Coverage Information
This section includes a chart that lists the main features of your medical plan option(s). It answers fundamental questions about the coverage levels of the plan options. It also provides specific information about coverage for different services, such as office visits, prescription drugs and emergency room services.
The coverage examples on the last two pages of the document show how the plan might cover medical care for two specific scenarios – “Having a Baby”, “Managing Type 2 Diabetes”, and “Simple Fracture”. The examples show what the plan would pay and what the patient would pay based on a common set of assumptions. It is important to note that these are examples only. They should not be used to estimate your actual costs under the plan.
The SBC explains how to access or request a glossary with definitions for common health insurance and medical terms, such as copayment and deductible. There may be differences between terms found in the Uniform Glossary and those in your health plan documents. In these instances, you should go by the terms in your health plan document.
Call Member Services if you have questions about your plan
Use the toll-free number on your medical ID card for any questions you may have. You can also e mail your questions to Member Services. Just log in to your secure Aetna Navigator® member website and click Contact Us.
It’s important your mailing address on file is correct; click here for more information.
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna).