Tuesday, March 12, 2013

Services Covered and Summary of Benefits Covered (SBC)

Healthcare.gov published an article on "Services Covered and Summary of Benefits Covered (SBC)" In the article, they highlighted the following bullets:

What services are covered under my insurance?
  • Coverage for Preventive Care
  • Coverage for Pre-Existing Conditions
    • Children's Pre-Existing Conditions
    • Pre-Existing Conditions for anyone
    • Temporary Exclusions in job-based plans
  • Coverage for Pregnancy under Job-Based Plans
  • Coverage under Small Employer Policies
How can i find out what is covered in my insurance plan?
  • Health Plan Summaries
    • Summary plan descriptions
    • Questions on job-based insurance?
    • More Information on What's Covered
What does my health insurance company or job-based plan have to disclose to me about my health coverage?
  • They must give you a SBC (Summary of Benefits and Coverage)
What's in a Summary of Benefits and Coverage (SBC)? 
  • Summary of benefits plan covers with cost-sharing associated with coverage.  The article lists the information it all covers.
When can I get an SBC?
  • You can get an SBC when you make a request, apply for coverage and more listed in the article
What other information may i need to make a decision about coverage?
  • Check the premium what access to doctors and prescription drug plans
Can I get the SBC in languages other than English?
  • Yes, if 10% of people speak another language you may request it in the other language.
Additional questions answered in the article were:
Will this SBC change throughout the year?
What if I have more questions?

To download the full article, please click the following link: Services Covered and Summary of Benefits Covered (SBC)

For additional billing, coding, and reimbursement resources, please click the following link: Medical Reimbursement Resources Page


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