Look for a Revised Summary of Benefits and Coverage Template

Look for a Revised Summary of Benefits and Coverage Template

Starting on or after Nov. 30, 2016, customers will receive a revised Summary of Benefits Coverage template due to new, federal mandates. In April, the federal government announced key enhancements to the SBC template and Uniform Glossary. Some improvements include:

  • An additional coverage example
  • Language and terms to improve readability and consumers’ understanding of their health coverage

The following table shows the key changes:

Changes to 2017 SBC template
Element What changed?
Important Questions
  • Some removed, modified or new
Common Medical Events
  • Some services removed or added
Font
  • Font changed from Garamond 12 to Arial narrow 12
Number of Coverage Examples
  • Three examples are now required
  • Added simple fracture and ER visit
  • Two coverage examples were previously required
Definitions
  • Co-pay, coinsurance definitions removed from the header on page two (2)
FAQ Page
  • Removed (was last page on previous template)

Who is responsible for preparing and delivering the SBCs?
Issuers and groups have the same requirements to prepare and deliver the SBCs.

Group Who prepares the SBCs? Where are the SBCs/template(s)?
Fully-funded Blue Cross Blue Shield of Michigan and Blue Care Network prepare SBCs for fully-funded groups.
  • Members are able to retrieve SBCs on bcbsm.com or call the number on the back of their ID card.
  • Blue Cross members can access their plan SBC by logging into the Group Secured Services portal. They can also contact their sales representative or agent for a copy.
  • BCN members should contact their sales representative or agent for a copy.
Self-funded These groups are responsible for creating and providing the group’s SBCs.
  • Blue Cross will continue to provide group-specific SBC templates in Word format on the Group Secured Services portal. Group members can also contact their sales representative or agent for a copy.
  • BCN members can contact their sales representative or agent for a copy.

To view sample SBCs, visit CMS.gov or click here.

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Photo Credit: Roger H. Goun

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