Decoding Insurance Documents

Some documents are legally required to be shared with anyone participating in a health insurance plan.

They detail benefits coverage, features, how they operate, etc. Two of these documents are called Summary Plan Descriptions (SPDs) and Summary of Benefits and Coverage (SBCs), which are available to all eligible participants of a plan.

Summary Plan Descriptions are summaries of the benefits offered to eligible participants under a benefits plan. Plan administrators are legally obligated to provide the SPDs free of charge to the plan participants. These describe what the plan provides, how it operates, when an employee can begin to participate in the plan, and how to file a claim. If a change is made, participants must be informed.

A Summary of Benefits and Coverage details the benefits and coverage under the applicable plan. These are created from a template that should use clear language to summarize plan features, cost-sharing provisions, covered benefits, and coverage limitations. These must be provided to participants with written application materials, upon request, upon special enrollment and at renewal.

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