Nov. 1, 2017

Small Group SBC Updates

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
RS08
RS16
"Deductibles" was added to “What is not included in OPX limit?” answer on Page 1.
Small Group
English
Spanish
RS18 (with and without maternity)
The 25-visit limitation was removed from the mental health, behavioral health and substance abuse outpatient services Limitations & Exceptions column.

The 10-day visit limitation was removed from the mental health, behavioral health and substance abuse inpatient services Limitations & Exceptions column.
Small Group
English
Spanish
RS20 (with and without maternity)
The in-network out-of-pocket limit amount was changed to $4,000 for individual.

The in-network out-of-pocket limit amount was changed to $12,000 for family.

The out-of-network out-of-pocket limit amount was changed to $8,000 for individual.

The out-of-network out-of-pocket limit amount was changed to $24,000 for family.

“Deductibles" was added to the “What is not included in the out-of-pocket limit?” answer on Page 1.

 
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