Skip to main content
off the charts

What’s Covered? And How Much Will It Cost?

It’s often hard to decipher the fine print of different health insurance plans to figure out what’s covered and how much you have to pay.  But starting this fall, it should get a whole lot easier, thanks to a little-known provision of health reform.

As of September 23, private health insurers must provide a standardized form called a Summary of Benefits and Coverage (SBC) that lists a health plan’s benefits, cost-sharing charges, and other details.  It’s designed to provide consumers with easier-to-understand, “apples-to-apples” information about their health coverage options.

The SBC also explains common health insurance terms, such as “deductible” and “out-of-pocket” limit.  And it includes coverage examples, modeled on the nutrition labels for food, to show what a sample enrollee would pay out of pocket when, say, giving birth or undergoing diabetes treatment.

Many people with employer-provided coverage will have an open enrollment period this fall to sign up for 2013 coverage, and the SBC will be particularly helpful in assessing their employer’s plan options.  People buying insurance on their own can also request an SBC.  Insurers must prepare SBCs for all private health plans, whether provided through an employer or purchased in the individual market.

Here’s a sample SBC, along with helpful tips on how to read it from Consumers Union, the publisher of Consumer Reports.  Consumers Union is also collecting feedback on the form from consumers that could make it even better in the future.