February Issue
January 25, 2015

Understanding health insurance plans

Author: By Sue Klug
Source: NYSUT United
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Many people find understanding health insurance plans a daunting task. Why couldn't someone design an easy-to-read summary of benefits using a standard format that would help people compare different plans?

Fortunately, the Affordable Care Act, beginning in 2012, requires all employers and plan sponsors to provide a Summary of Benefits and Coverage (SBC) to employees. Often the SBC is posted on the employer's internal website, and is included with open enrollment materials to help individuals compare health plan options.

The SBC lists how much it will cost participants (copays, deductibles and coinsurance) for most hospital, medical and prescription drug services. It indicates whether the health plan uses a network of participating doctors and hospitals, if referrals are required, and what coverage is excluded. The SBC also provides examples showing how the health plan would pay for a routine pregnancy, and services required to manage type 2 diabetes. A glossary of health insurance terms is also part of the SBC.

Ask your employer how to obtain your SBC. If you encounter difficulties, please contact the officers of your local union.

— Sue Klug

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