Information on the Standardized Summary of Benefits and Coverage
You may have heard about the Standardized Summary of Benefits and Coverage or SBC, a new document created by the Affordable Care Act (the federal health reform law). We want to help you learn more about this new information and what it will mean to how you understand health insurance benefits.
Below are answers to questions you may have about this new document and a link that you can use to download your SBC.
What is an SBC?
SBCs are intended to help consumers make "apples to apples" comparisons of health plans when shopping for coverage. This document provides a brief overview of health insurance as it relates to a specific plan. Because the law requires a standard format, it will help consumers understand how one plan compares to another.
Included on all SBCs is information on covered health services and the level at which they are covered. They also show answers to frequently asked questions, coverage scenarios and sample cost projections for certain medical services and more. A Uniform Glossary is separately available as well in English,Spanish, Chinese, Navajo and Tagalog to help you understand important insurance-related terms.
SBCs are available in four languages. SBCs for GHI plans are available in English, Spanish, Chinese, Tagalog and Navajo. SBCs for HIP plans are available in English, Spanish, Chinese, Russian and Polish.
When are SBCs available and does this rule apply to everyone?
Effective September 23, 2012, the federal health reform law requires insurers and health plans to offer a standardized SBC and make available a Uniform Glossary in certain circumstances, such as when you apply for coverage or during your group health plan's annual open enrollment. You can also request an SBC from your insurer or group health plan at any time. SBCs are available in connection with most fully-insured and self-insured health plans, regardless of grandfathered status.
They are generally not available in connection with Medicare plans, stand-alone dental and/or vision plans and other types of coverage exempted from the Affordable Care Act.
How can I get a copy of the SBC and the Uniform Glossary?
To download a copy of the Uniform Glossary, please select the language needed: English, Spanish, Chinese, Navajo and Tagalog.
To download a copy of an SBC for the plans administered by EmblemHealth, please use the appropriate link below:
You can also call us using the proper number below and ask that an SBC be delivered to you by mail, free of charge.
For plans issued by HIP, call: 1-800-447-8255. If you have a hearing or speech impairment and use a TDD, call: 1-888-447-4833
For plans issued by GHI, call 1-800-624-2414. If you have a hearing or speech impairment and use a TDD, call: 1-866-248-0640
For plans issued by GHI HMO, call 1-877-244-4466. If you have a hearing or speech impairment and use a TDD, call 1-877-208-7920
For EmblemHealth CompreHealth HMO/EPO, call 1-877-842-3625. If you have a hearing or speech impairment and use a TDD, call 1-866-248-0640