July 26, 2017

SBCs Updated on Online Document Retrieval Tool

You may have recently retrieved a Summary of Benefits and Coverage (SBC) from the Standard SBC tool that describes an overview of what members’ plans cover and their level of cost sharing for those services. Updates have been processed and new versions of the documents are now available in the tool to retrieve.

Review the list of 2017 changes below for more details on the updates, and always review the SBC for accuracy before distributing to members.

Market Segment
Language
Plan ID
Change Made
Small Group
English
Spanish
B652CHC
The in-network outpatient mental health, behavioral health & substance abuse services amounts were changed from a $40 copay for office visits or 40% coinsurance for other outpatient services to 40% coinsurance only.
Large Group
English
Spanish
LG10x
The specialty drugs retail copayment amounts were changed from $10/$40/$6 to $10/$40/$60.
Mid-market Group
English
Spanish
MPlan41
The individual and family out-of-pocket expense limits were changed from $6,150/$11,300 to $5,850/$10,700.
Mid-market Group
English
Spanish
MM15
The generic drugs mail copayment amount was changed from $60 to $45.
The preferred brand drugs retail copayment amount was changed from $45 to $40.
The preferred brand drugs mail copayment amount was changed from $135 to $120.
The specialty drugs retail copayment amounts were changed from $15, $45 and $55 to $15, $40 and $55.
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