The Summary of Benefits and Coverage (SBC) is a standardized document every health insurance plan is required to provide. It gives you a plain-language overview of what a plan covers, what it costs, and how it handles key scenarios — all in a consistent format so you can compare plans side by side.
Every SBC includes:
The SBC is not your full plan documents — it’s a summary. For complete benefit details, request your plan’s Evidence of Coverage (EOC) or Certificate of Coverage. But for comparison shopping during Open Enrollment, the SBC is your most efficient tool.
Insurers are required to provide the SBC before you enroll and upon request at any time.
Ask your insurer or check your plan documents. For Marketplace plans, the SBC is available on HealthCare.gov when you’re comparing plans. For employer plans, your HR department is required to provide it. You can also request it directly from your insurer at any time.
Read the coverage examples — they show estimated total costs for two standardized health situations, so you can see roughly what you’d pay on each plan. Compare the deductibles, out-of-pocket maximums, and cost-sharing for services you actually use (primary care, specialist visits, prescriptions). Don’t just look at the premium.
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