Short answer: An SBC must include standardized details about a health plan’s benefits, costs, coverage limitations, and real-world coverage examples so plans can be compared easily.
A Summary of Benefits and Coverage (SBC) must follow a federally prescribed format and include specific standardized information designed to help individuals understand and compare health plans.
An SBC must describe key cost-sharing features of the plan, including deductibles, copayments, coinsurance, and out-of-pocket maximums, as well as any important limits on coverage. It must also explain which services are covered and which services are excluded, along with any requirements for referrals, prior authorization, or other conditions affecting access to care.
The SBC must include standardized coverage examples that illustrate how the plan would pay for common medical situations. These examples are intended to show how deductibles and cost-sharing work in practice, such as the costs associated with having a baby or managing a chronic condition like Type 2 diabetes.
In addition, the SBC must reference a uniform glossary of health insurance terms, either by including it with the SBC or by providing a link to where it can be accessed. This glossary helps ensure consistent understanding of commonly used insurance terms.
Federal rules also specify formatting and language requirements. SBCs must be written in plain language, be culturally and linguistically appropriate, and follow strict length and font rules. Generally, an SBC may not exceed four double-sided pages and must use a minimum 12-point font.
Sources
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Centers for Medicare & Medicaid Services, Summary of Benefits and Coverage (SBC)
https://www.cms.gov/cciio/resources/forms-reports-and-other-resources/summary-of-benefits-and-coverage -
U.S. Department of Labor, SBC Templates and Instructions
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/sbc-template -
Affordable Care Act, Section 2715
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29 CFR §2590.715-2715
Content history
Originally published: June 16, 2025
Last reviewed: January 25, 2026