Summary of Benefits and Coverage (SBC)

Summary of Benefits and Coverage (SBC)

The Affordable Care Act requires that health plans like the Fund provide an SBC at important points in the enrollment process. The purpose of the SBC is: (1) to summarize the Fund’s benefits and coverage; and (2) to summarize the Fund’s benefits in a standard format that allows an “apples-to-apples” comparison. The Fund, like all health plans, must use the same standard SBC form to help you compare health plans.

Additional information is contained in the “Letter Accompanying Summary of Benefits and Coverage” below.

If you aren’t clear about any of the underlined terms used in the SBC, click here to see the Glossary.

Documents Related to Summary of Benefits and Coverage (SBC)

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2019 SBC’s

Plan 13 SBC
Plan 13Y SBC
Plans 14-1; 14-15; 14-19; 14-26; 14-30, 14-34,14-P

Core Medical (A) plus Mental/Substance; Dental (A); Prescription (A); Vision/Hearing

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Plans 14-2; 14-20; 14-23; 14-33

Core Medical (A) plus Mental/Substance; Prescription (A); Vision/Hearing

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Plans 14-3

Core Medical (A) plus Prescription (A); Vision/Hearing

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Plans 14-4

Core Medical (A) plus Mental/Substance; Prescription (B)

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Plans 14-5

Core Medical (A) plus Dental (A); Prescription (A)

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Plans 14-6; 14-13

Core Medical (A) plus Prescription (A)

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Plans 14-7; 14-24

Core Medical (A) plus Prescription (A); Vision/Hearing

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Plans 14-8; 14-9; 14-18; 14-25

Core Medical (A) plus Mental/Substance; Prescription (A)

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Plans 14-10; 14-17; 14-27

Core Medical (A) plus Mental/Substance; Dental (B); Prescription (B); Vision/Hearing

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Plans 14-11; 14-16

Core Medical (A) plus Mental/Substance; Dental (B); Prescription (A); Vision/Hearing

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Plans 14-12

Core Medical (A) plus Mental/Substance; Dental (C); Prescription (B); Vision/Hearing

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Plans 14-14

Core Medical (A) plus Prescription (B); Vision/Hearing

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Plans 14-21

Core Medical (A) plus Mental/Substance; Dental (B); Prescription (B)

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Plans 14-22

Core Medical (A) plus Prescription (B); Vision/Hearing

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Plans 14-28

Core Medical (B) plus Mental/Substance (B); Dental (A); Prescription (B); Vision/Hearing

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Plans 14-29

Core Medical (A) plus Mental/Substance; Dental (A); Prescription (B); Vision/Hearing

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Plan 14-31; 14-35

Core Medical (C) plus Mental/Substance (C); Dental (B); Prescription (C); Vision/Hearing

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Plans 14-32

Core Medical (C) plus Mental/Substance (C); Dental (B); Prescription (C); Vision/Hearing

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Plan 16-1; 16-4; 16-5; R6-1; R6-2

Core Medical plus Mental/Substance; Dental (A); Prescription (A); Vision/Hearing

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Plan 16-2; R6-8

Core Medical plus Prescription (A)

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Plan 16-3

Core Medical plus Dental (A); Prescription (A); Vision/Hearing

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Plan 16-6

Core Medical plus Mental/Substance; Prescription (B)

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Plan R6-5

Core Medical plus Mental/Substance; Dental (A); Prescription (A); Vision/Hearing

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Plan R6-13

Core Medical plus Prescription (A)

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Plan R7
Plan R7-65

2018 SBC’s

Plan 13 SBC
Plan 13Y SBC
Plans 14-1; 14-15; 14-19; 14-26; 14-30, 14-34,14-P

Core Medical (A) plus Mental/Substance; Dental (A); Prescription (A); Vision/Hearing

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Plans 14-2; 14-20; 14-23; 14-33

Core Medical (A) plus Mental/Substance; Prescription (A); Vision/Hearing

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Plans 14-3

Core Medical (A) plus Prescription (A); Vision/Hearing

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Plans 14-4

Core Medical (A) plus Mental/Substance; Prescription (B)

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Plans 14-5

Core Medical (A) plus Dental (A); Prescription (A)

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Plans 14-6; 14-13

Core Medical (A) plus Prescription (A)

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Plans 14-7; 14-24

Core Medical (A) plus Prescription (A); Vision/Hearing

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Plans 14-8; 14-9; 14-18; 14-25

Core Medical (A) plus Mental/Substance; Prescription (A)

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Plans 14-10; 14-17; 14-27

Core Medical (A) plus Mental/Substance; Dental (B); Prescription (B); Vision/Hearing

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Plans 14-11; 14-16

Core Medical (A) plus Mental/Substance; Dental (B); Prescription (A); Vision/Hearing

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Plans 14-12

Core Medical (A) plus Mental/Substance; Dental (C); Prescription (B); Vision/Hearing

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Plans 14-14

Core Medical (A) plus Prescription (B); Vision/Hearing

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Plans 14-21

Core Medical (A) plus Mental/Substance; Dental (B); Prescription (B)

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Plans 14-22

Core Medical (A) plus Prescription (B); Vision/Hearing

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Plans 14-28

Core Medical (B) plus Mental/Substance (B); Dental (A); Prescription (B); Vision/Hearing

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Plans 14-29

Core Medical (A) plus Mental/Substance; Dental (A); Prescription (B); Vision/Hearing

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Plan 14-31; 14-35

Core Medical (C) plus Mental/Substance (C); Dental (B); Prescription (C); Vision/Hearing

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Plans 14-32

Core Medical (C) plus Mental/Substance (C); Dental (B); Prescription (C); Vision/Hearing

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Plan 16-1; 16-4; 16-5; R6-1; R6-2

Core Medical plus Mental/Substance; Dental (A); Prescription (A); Vision/Hearing

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Plan 16-2; R6-8

Core Medical plus Prescription (A)

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Plan 16-3

Core Medical plus Dental (A); Prescription (A); Vision/Hearing

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Plan 16-6

Core Medical plus Mental/Substance; Prescription (B)

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Plan R6-5

Core Medical plus Mental/Substance; Dental (A); Prescription (A); Vision/Hearing

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Plan R6-13

Core Medical plus Prescription (A)

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Plan R7
Plan R7-65