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
There are two ways to see a plan's SBC.
- You’ll find a link to the SBC on each plan page when you preview plans and prices. You’ll also see the link when you've finished your application and are comparing plans.
- You can ask for a copy from your insurance company or employer at any time. You will be provided the SBC at important points in the enrollment process, such as when you apply for or when you renew coverage. You also can get a copy of the uniform glossary to explain terms used in the 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.
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.
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:
Learn about international, student and voluntary benefits
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
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
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.
