BluePride SBCs 2015

Summaries of Benefits and Coverage

The Summary of Benefits and Coverage (SBC) is a standard document produced by all health insurance companies to help employers and employees understand their benefits and/or compare plans. Please view our BluePride SBCs here:

2015 Plans

Gold Option 101*
Gold Option 102
Gold Option 103
Gold Option 104
Gold Option 105 HSA
Gold Option 106 HSA

Silver Option 201*
Silver Option 202
Silver Option 203 HSA
Silver Option 204 HSA

Bronze Option 301 HSA 
Bronze Option 302 HSA
Bronze Option 303
Bronze Option 304 HSA 
Bronze Option 305 HSA
Bronze Option 306 HSA
Bronze Option 307 HSA

*These options are offered on and off SHOP.

Due to the Affordable Care Act (ACA, otherwise known as heath care reform), employers now have two options for offering health insurance to their employees:

  1. Employers can buy health insurance that complies with the health care law the same way as before the ACA – through their agent/broker.
  2. Employers can buy from the Small Business Options Program (SHOP) Marketplace. In 2015, small businesses and their employees will be able to choose from multiple carriers.

The SHOP, or SHOP Marketplace, is an online option for small business owners to shop for and purchase health care coverage for their employees. The SHOP opened on October 1, 2013. It was developed to give business owners a convenient place to compare health care plans. The standardized “metallic”plans, such as Gold, Silver, and Bronze, allow business owners to compare plans with similar levels of coverage.

HEALTH INSURANCE TERMS


COINSURANCE

The percentage of the bill you pay after your deductible has been met.

COPAY

A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 

DEDUCTIBLE

The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.

SUBSTANCE ABUSE DISORDER SERVICES

Includes behavioral health treatment, counseling, and psychotherapy


in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)

out-of-pocket

Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.

penalty

If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.

premium

The amount you pay to your health insurance company each month. 


Preventive services

Health care services that focus on the prevention of disease and health maintenance.

rehab SERVICES

Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).

specialist

A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.