What is a Summary of Benefits and Coverage (SBC)?

SBCs are required under the federal Affordable Care Act to help members understand plan benefits and medical terms.

SBCs help you compare things like:

  • Whether there are services a plan doesn't cover
  • What isn't included in a plan's out-of-pocket limit
  • Whether you need a referral to see a specialist

PEBB and/or medical plans provide SBCs, or notice of how to get one, at different times throughout the year (like when you apply for coverage, renew your plan, or request an SBC). SBCs are available (upon request) in English, Spanish, Tagalog, Chinese, and Navajo.

SBCs don't replace PEBB's medical benefit comparison tool, or plans' certificates of coverage.

Summaries of Benefits and Coverage

 

Group Health

Kaiser Permanente
Uniform Medical Plan (UMP)
administered by Regence BlueShield

Note: SBCs are not available for Medicare Advantage plans and Medicare supplement plans. For PEBB Medicare plan summaries, see the medical benefit comparison tool.