Under the Affordable Care Act (ACA), you must receive a Summary of Benefits and Coverage (SBC) document. It explains your benefits. It also has examples of how much you might pay out of pocket for certain health services. All SBCs must follow a standard format. This makes it easier to compare health plans and costs.
There are two ways to see a plan's SBC.
The SBC includes the name of your health plan. This information is helpful when checking:
If you're already a member, you can find health care provider and drug information on your secure member website.
If you're not a member yet, look up doctors in our provider directory. Choose the plan name that matches the one in your SBC.
You also can look up drug coverage without logging in. You’ll need to know your pharmacy plan name. Beginning in 2017, you can find the pharmacy plan name on your SBC.
Remember, the SBC is only a summary. You can link from the SBC to your plan documents which contain the complete details about the health plan.
You can review your plan documents to see:
Here's how to get a sample plan policy document.
Note: This is a sample document for your information only. Legal entity, plan terms and benefits, including cost sharing, may vary from your actual coverage based on the plan selected and state mandates which are not reflected in this sample document.
If you're covered under an employer that has 50 or fewer employees:
If you're covered under an employer that has 51 or more employees:
If you already have an Aetna health plan, just call the Member Services number on your ID card. Or call us at one of these numbers.
Aetna plan members:
On exchange: 1-855-586-6960
Off exchange: 1-866-253-8885
Leap plan members:
AZ, NC, PA, SC: 1-844-241-0208
VA (Innovation Health plan): 1-844-289-4503
AZ, DE, IA, IL, NC, NE, PA, SC, TX: 1-844-241-0208
VA (not Innovation Health plan): 1-844-241-0208
VA (Innovation Health plan): 1-844-289-4503
CT, FL, GA, KS, KY, ME, MI, MO, NJ, NV, NY, OH, TN, WV
On exchange: 1-855-586-6960
Off exchange: 1-866-253-8885
Aetna plan members
On exchange: 1-855-885-3289
Off exchange (non-HMO): 1-888-802-3862
Off exchange (HMO): 1-866-529-2517
Innovation Health:
1-855-330-4545
Aetna Fund Advantage (AFA) Small Group
1-888-982-3862
Allina Health: 1-855-337-7170
Banner Health: 1-877-312-3862
Texas Health: 1-800-261-2441
Small Group
Texas Health: 1-800-596-4015
Banner Health: 1-877-312-3862
We’ll give employers the information they need. But the law says employers have to give the SBCs to their employees. There are specific rules about what employers have to provide and when.
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