Short answer: An SBC (Summary of Benefits and Coverage) is a standardized document that summarizes a health plan’s key features and costs, and it is required under the Affordable Care Act to help people compare health plan options.
A Summary of Benefits and Coverage (SBC) is a federally required document that provides a high-level overview of what a health plan covers and what participants are expected to pay. The SBC uses a standardized format so that individuals can compare different health plans side by side, even when the plans are offered by different insurers.
The Affordable Care Act requires SBCs to promote transparency and help consumers make informed enrollment decisions. This requirement is especially important during open enrollment periods, when employees or individuals may be choosing among multiple plan options.
An SBC includes key plan details such as deductibles, out-of-pocket maximums, and how common medical services are covered. It explains whether services are subject to copays or coinsurance and identifies major covered and excluded benefits.
SBCs also include standardized coverage examples, such as the cost of having a baby or managing a chronic condition, to help illustrate how the plan works in real-world situations. In addition, the SBC states whether the plan meets minimum essential coverage and minimum value requirements under federal law.
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 -
Affordable Care Act, Section 2715
Content history
Originally published: June 16, 2025
Last reviewed: January 25, 2026