Health insurance documents 101: The following four member documents are important. They include:
1 Your Member Certificate This is detailed information explaining how your plan works and what medical benefits you have. You’ll find information like patient rights, benefit limitations and exclusions, cost-sharing requirements, and prior authorization requirements.
2 Summary of Benefits and Coverage (SBC) An SBC is a snapshot of
Dean Health Plan’s costs, benefits, covered health care services, and other features. It also explains our unique features like cost-sharing rules and includes significant limits and exceptions to coverage in easy-to-understand terms.
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Summary of Employer-Specific Coverage This summary is specific to your company’s coverage information, and it is included with this packet. You can also ask your plan administrator or benefits specialist for your specific benefits and coverage information.
Schedule of Benefits
This document lists the services and treatments
covered by your health plan and their associated fees. It is important to read the schedule of benefits carefully and contact customer care if anything is unclear.
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