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Summary of Benefits & Coverage

The basics about your health benefits

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.

Where to find your plan's SBC
How to use your SBC

The SBC includes the name of your health plan. This information is helpful when checking:

  • Which doctors, hospitals and other providers are in our network
  • Which prescription drugs the plan covers

If you're already a member, you can find health care provider and drug information on your secure member website.

Log in to your secure 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.

Find a doctor

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.

Search your plan’s drug list (formulary)

Get other important documents

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:

  • What services will and will not be covered
  • Conditions you must meet to receive benefits
  • When and in what form benefits are paid
  • When you need approval before getting a service
  • How to file a claim for benefits

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:

See our small group sample policy document

If you're covered under an employer that has 51 or more employees:

See our large group sample policy documents

Learn about international, student and voluntary benefits

For international plans:

Visit Aetna International

For student plans:

Visit Aetna Student HealthSM

For voluntary benefits:

Visit Aetna Voluntary Plans

Contact Us

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

Individual plans effective in 2016

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

Individual plans effective in 2017

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

Small Group plans

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

Important information for employers

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.

Read about standards for the SBC

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