Summary of Benefits & Coverage

Important information for individuals

What you need to know

It’s easy to know about your benefits and coverage

In March 2010, Congress passed a historic health care reform law called the Affordable Care Act (ACA).  Under it, health plans are required to provide consumers with a document giving them information about health plan benefits and coverage. This is a Summary of Benefits and Coverage (SBC) document.

The SBC gives you helpful information about what the plan covers. It also has examples of how much you might pay for certain health events or conditions. Remember, the SBC is only a summary. So, we’ve added other details about your plan here for you.

Be sure to visit these links for more information:

Find out what the bolded words in the SBC mean. Check out our glossary of coverage and medical terms. (Note: Some of the terms may not have the same meaning when used in your policy or plan. Your policy or plan governs)

Need to know which providers are in Banner|Aetna’s network or have questions about prescription drug coverage?

• Current Banner|Aetna members: Just login to your secure member website using the link in the navigation bar to get information about your current plan.
  
  
• Not a member yet:

1. To check if a doctor is in network, go to our provider search tool and make sure to choose the plan that matches the one you are considering.
   
   
2. For pharmacy benefit information, visit our pharmacy resources page.  Banner|Aetna pharmacy benefits are administered by Aetna. Aetna provides certain management services to Banner|Aetna.
   
   Please note that these formularies are standard and may not reflect the formulary in your specific plan.

To obtain the terms of your policy or a copy of your plan document, please see below. Which policy or plan document do you need?

• Does your employer have less than 50 employees?
  • Read more about our 1-50 policy certificates.
• Does your employer have more than 50 employees?
  • Read more about our 51+ policy certificates.

Questions?

Already a Banner|Aetna member? Call Member Services at the toll-free number on your member ID card.

Not a member yet? Call the toll-free number on your SBC if you have any questions.

Important information for employers

Banner|Aetna will give employers the information they need, but the law says employers have to give the SBCs to their employees. There are very specific rules about what employers have to provide and when. Read more about the standards to create and provide an accurate SBC.