Getting to know your Summary of Benefits and Coverage

Getting to know your Summary of Benefits and Coverage

May 1, 2019
Post-it note with health care benefits notedIt’s the law. Most insurance companies and group health plans must provide us with easy-to-read summaries of common services that are covered—and some that aren’t—by our health insurance plans.  These documents are meant to help us compare the features of different plans and can help with decisions about which health plan to choose. The Summary of Benefits and Coverage (SBC) also has information about what we can expect to pay, if anything, for medical services and prescription drugs.

Each of the health plans offered through the Texas Employees Group Benefits Program (GBP), except the Medicare Advantage plans, has an SBC on the ERS website.  And, while each health plan is different, the SBCs present the information in the same way. 
 

Looking closer

For example, in the frequently asked questions (FAQ) section of each SBC, some terms are underlined. You can find definitions to all underlined terms in the Glossary of Health Coverage and Medical Terms.

Chart of health care definitions and terms

Another part of the summary shows each health plan’s costs and common covered health care services.
Chart of health care definitions and terms
And all SBCs include examples of how a plan might cover common health conditions, such as pregnancy or Type 2 diabetes.

Chart of health care definitions and terms
‚ÄčOf course, these are just examples of coverage. Costs for medical services and treatments will depend on each unique medical situation. 

The SBCs for Plan Year 2019 are available online. New summaries, for PY 2020, will be posted by the start of Summer Enrollment.
  
Consider reviewing the SBC for your health plan before Summer Enrollment. Does your plan continue to provide the best coverage for you and your family? 

For more information, see Understanding the Summary of Benefits and Coverage (SBC).