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. To view any of our BlueFreedom SBC documents, please select from the following options:   

2015 BlueFreedom Plans

Opt 1/Rx Opt 1            Opt 1/Rx Opt 2           Opt 1/Rx Opt 5
Opt 6/Rx Opt 1 Opt 6/Rx Opt 2 Opt 6/Rx Opt 5
Opt 8/Rx Opt 1 Opt 8/Rx Opt 2 Opt 8/Rx Opt 5
Opt 11/Rx Opt 1  Opt 11/Rx Opt 2    Opt 11/Rx Opt 5
Opt 15/Rx Opt 1 Opt 15/Rx Opt 2 Opt 15/Rx Opt 5
Opt 18/Rx Opt 1 Opt 18/Rx Opt 2 Opt 18/Rx Opt 5
Opt 19/Rx Opt 1 Opt 19/Rx Opt 2 Opt 19/Rx Opt 5
Opt 20/Rx Opt 1 Opt 20/Rx Opt 2 Opt 20/Rx Opt 5
Opt 21/Rx Opt 1 Opt 21/Rx Opt 2 Opt 21/Rx Opt 5
Opt 23/Rx Opt 1 Opt 23/Rx Opt 2 Opt 23/Rx Opt 5
Opt 25/Rx Opt 1 Opt 25/Rx Opt 2 Opt 25/Rx Opt 5
Opt 26/Rx Opt 1 Opt 26/Rx Opt 2 Opt 26/Rx Opt 5
Opt 28/Rx Opt 1 Opt 28/Rx Opt 2 Opt 28/Rx Opt 5
Opt 29/Rx Opt 1 Opt 29/Rx Opt 2 Opt 29/Rx Opt 5
Opt 31/Rx Opt 1 Opt 31/Rx Opt 2 Opt 31/Rx Opt 5
Opt 32/Rx Opt 1 Opt 32/Rx Opt 2 Opt 32/Rx Opt 5
Opt 34/Rx Opt 1 Opt 34/Rx Opt 2 Opt 34/Rx Opt 5
Opt 35/Rx Opt 1 Opt 35/Rx Opt 2 Opt 35/Rx Opt 5
Opt 36/Rx Opt 1 Opt 36/Rx Opt 2 Opt 36/Rx Opt 5
Opt 39/Rx Opt 1 Opt 39/Rx Opt 2 Opt 39/Rx Opt 5
Opt 40/Rx Opt 1 Opt 40/Rx Opt 2 Opt 40/Rx Opt 5
Opt 41/Rx Opt 1 Opt 41/Rx Opt 2 Opt 41/Rx Opt 5
Opt 42/Rx Opt 1 Opt 42/Rx Opt 2 Opt 42/Rx Opt 5
Opt 43/Rx Opt 1 Opt 43/Rx Opt 2 Opt 43/Rx Opt 5
Opt 44/Rx Opt 1 Opt 44/Rx Opt 2 Opt 44/Rx Opt 5
Opt 48
Opt 49
Opt 51
Opt 52
Opt 54
Opt 55
Opt 56
Opt 57
Opt 58
Opt 59
Opt 60
Opt 65/Rx Opt 1 Opt 65/Rx Opt 2 Opt 65/Rx Opt 5
Opt 66




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


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. 


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.


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.)


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


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.


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.


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).


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.