Know What's Covered

When unexpected illnesses or injuries come up, knowing what your health plan covers and doesn’t cover can be confusing. This information could be the difference between paying a small percentage of healthcare costs, known as a copay or coinsurance, or paying the entire bill.

Luckily, insurance providers provide resources that break down the most common services and how much you will pay out-of-pocket for them. These resources include documents such as a summary of benefits and coverage (SBC) and online resources through the carrier website.

Summary of Benefits and Coverage
A summary of benefits and coverage (SBC) is a snapshot of a health plan’s costs, benefits, covered health care expenses, and other features that may be important to you.

Most Important Sections of an SBC
Important Questions: These are the most commonly asked questions for benefits. Read through these carefully until you find your question.
Answers: These answers often have terms that may be unfamiliar, so refer to the Glossary at the top of the SBC.
Why This Matters: This section explains exactly how the answer is applicable to you using specific examples.

Carrier Resources
All insurance providers will have easy-to-access websites that allow you to learn more about your benefits, including:

Provider Search: Provider search tools will help you find in-network providers nearby that can help provide the care you’re looking for.
Helpful Content: These websites will often offer content that breaks down complicated concepts into terms you can understand.
Cost Calculator: Cost calculators allow you to input what service you need and give you an estimate of the out-of-pocket cost.

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