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Summary of Benefits and Coverage

The summary of benefits (SBC) is a document provided by your insurance company that explains in plain language the benefits of your plan and what your plan covers. The SBC summarizes key features of your plan and uses an easy-to-understand question-and-answer format. SBCs are also available to consumers as they shop and compare plans on MNsure.

Some of the information you will see on your SBC:

  • The overall deductible
  • Deductibles for specific services
  • Out-of-pocket limit on your expenses
  • What is not included in the out-of-pocket limit
  • If there is a network of providers
  • A link to the provider directory
  • If a referral is needed to see a specialist
  • Services the plan generally does not cover
  • Your cost if you use a network provider
  • Your cost if you use an out-of-network provider
  • How prescription medications are covered
  • Links to the glossary of health coverage and medical terms (terms that are defined in the glossary are underlined in the SBC)
  • Coverage examples
  • Insurance company websites and phone numbers
  • Phone numbers for language access services

Example summary of benefits document (PDF)

If you have questions about the information on your SBC, contact your insurance company.

Your summary of benefits and coverage gives a good overview about your plan, but it will not contain all the details and rules about your plan. You'll find that information on an evidence of coverage document for your plan.

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