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Summary of Benefits and Coverage
Under the Affordable Care Act, health insurers and group health plans are required to provide individuals with clear, consistent and comparable information about their health plan benefits* and coverage. Specifically, the regulations ensure consumers have access to two forms that will help them understand and evaluate their health insurance choices.
The forms include:
- An easy-to-understand Summary of Benefits and Coverage
- A uniform glossary of terms commonly used in health insurance coverage such as "deductible" and "co-payment"
*Health plan benefits include UC’s medical plans and Employee Assistance Plan (EAP).
The Summary of Benefits and Coverage document will help individuals better understand the coverage they have and allow them to easily compare different coverage options. It summarizes the key features of the plan or coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions.
Coverage Examples
The Summary of Benefits and Coverage is required to include a new, standardized health plan comparison tool for consumers called “coverage examples,” much like the Nutrition Facts label required for packaged foods. The coverage examples illustrate how a health insurance policy or plan would cover care for common benefits scenarios. Using clear standards and guidelines provided by the Center for Consumer Information and Insurance Oversight (CCIIO), plans and issuers will simulate claims processing for each scenario so consumers can see an illustration of the coverage they get for their premium dollar under a plan. The examples will help consumers see how valuable the health plan will be at times when they may need the coverage.
A standardized template is used for by all health insurers and group health plans. Downloadable versions of UC’s Summary of Benefits and Coverage can be found at the links below. For a paper copy contact UC Human Resources at 513-556-6381.
Active Employee Medical Plans
Employee Assistance Plan (EAP)
Uniform Glossary of Terms
Thanks to the Affordable Care Act, consumers will also have a new resource to help them understand some of the most common but confusing jargon used in health insurance.
The uniform glossary is available at these websites:
- www.HealthCare.gov (search ‘uniform glossary of terms’) and
- www.dol.gov/ebsa/healthreform
A PDF version of the uniform glossary is also available.