Benefits Made Simple

How to Read Your Summary of Benefits and Coverage (SBC)

Last checked: Nov 2026 · By the Benefits Made Simple author

Every health plan at work comes with a short document called the Summary of Benefits and Coverage, or SBC. It uses the same layout for every plan, which makes it the easiest way to compare your choices side by side. This guide shows you what's in it and how to use it.

What is an SBC?

HealthCare.gov calls the SBC an easy-to-read summary that lets you make apples-to-apples comparisons of costs and coverage between health plans. Insurance companies and job-based health plans must give you a short, plain-language SBC, along with a Uniform Glossary of common health coverage terms.

Federal rules (29 CFR 2590.715-2715) say the SBC must use a uniform format and words the average person can understand, run no more than four double-sided pages, and use print no smaller than 12-point.

When do I get one?

HealthCare.gov says you get an SBC when you shop for coverage on your own or through your job, when you renew or change coverage, or when you ask for one. Under the federal rules, a plan must send it within 7 business days after you ask. It's free.

You can also ask for the SBC and Uniform Glossary in a language other than English. HealthCare.gov says you may be able to get them on request.

What's NOT in the SBC?

The premium. The official SBC template says the cost of the plan, called the premium, is provided separately. Get your paycheck cost from your enrollment materials and add it to what you learn from the SBC.

Page 1: the "Important Questions"

The SBC starts with a short table of questions, answers, and "Why This Matters." Based on the government's SBC template, these are:

Question in the SBC What to look for
What is the overall deductible? How much you pay before the plan starts paying for most care
Are there services covered before you meet your deductible? Care the plan helps pay for right away, like preventive care
Are there other deductibles for specific services? Separate deductibles, for example for prescriptions
What is the out-of-pocket limit for this plan? The most you'd pay in a year for covered care
What is not included in the out-of-pocket limit? Costs that don't count toward that cap, like premiums
Will you pay less if you use a network provider? Whether going out of network costs more, and where to find the network list
Do you need a referral to see a specialist? Whether you need your primary doctor's OK first

New to these words? See Health insurance words explained.

The middle pages: what you pay for common care

Next comes a long table organized by "Common Medical Event," such as visiting a doctor, getting a test, filling a prescription, or going to the emergency room. For each one, the template shows:

  • What you pay with a network provider ("You will pay the least")
  • What you pay with an out-of-network provider ("You will pay the most")
  • Limitations, exceptions, and other important information, such as limits on the number of visits or a need for approval before care

The template notes that the copays and coinsurance in this chart apply after your deductible is met, if a deductible applies.

How to use it: Find the rows you're most likely to use (your prescriptions, specialist visits, therapy, a planned surgery or birth) and compare the same rows across each plan.

Excluded services and your rights

The SBC lists services the plan generally does NOT cover and other covered services. It also explains your rights to continue coverage (see COBRA explained) and to file a complaint or appeal. The template also says whether the plan provides Minimum Essential Coverage and meets the Minimum Value Standards. The template explains that if a job-based plan doesn't meet the Minimum Value Standards, you may be eligible for a premium tax credit for a Marketplace plan.

The coverage examples

The last page shows coverage examples. The current government SBC template uses three made-up situations:

  • Peg is Having a Baby: 9 months of in-network prenatal care and a hospital delivery
  • Managing Joe's Type 2 Diabetes: a year of routine in-network care for a well-controlled condition
  • Mia's Simple Fracture: an in-network emergency room visit and follow-up care

Each one shows the total example cost and how much the person would pay in deductibles, copays, coinsurance, and things that aren't covered. In the template, the total example costs are $12,700 for Peg, $5,600 for Joe, and $2,800 for Mia, so the same situations can be compared across plans.

The template is clear that this is not a cost estimator. Your real costs depend on the care you get and what your providers charge. The examples are based on self-only coverage. Use them to compare plans, not to predict your bill.

A 15-minute way to compare plans

  1. Put the SBCs for each plan side by side.
  2. Write down each plan's yearly premium (from your enrollment materials, not the SBC).
  3. Compare the deductible and the out-of-pocket limit.
  4. Compare the rows for the care you expect next year.
  5. Check the network and drug list links listed in the SBC.
  6. Look at Peg, Joe, and Mia: which plan makes the situation closest to yours cost less?
  7. For a "bad year" number, add the yearly premium and the out-of-pocket limit.

The SBC itself says it is only a summary. Federal rules require it to tell you that the plan document has the full terms of your coverage. See HMO vs PPO vs HDHP for help choosing a plan type.

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