Summary of Benefits Question

Under ACA are health care insurers required to provide full plan documents prior to enrollment deadline? I found that the Summary of Benefits documents do not disclose enough about coverage and my insurance company refused to provide full documentation until after I enrolled.


Answer

Your insurance company must provide a summary of benefits and coverage, they usually will have network and drug lists on their website. You can also browse their brochure or talk to a representative by calling. You are right though, an insurer may not have to disclose certain information. Feel free to comment and let us know what specific information you are unable to obtain so we can address this further.

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William Ahrens on

my insurance does not have a summary of benefits for my bronze plan. I am through with any needed health services and want to pay my bills. it is very unclear on coventry’s website and my claims. i cannot meet my deductible with my share of out of cost pocket at approximately $5800 dollars with my out of pocket maximum is $6450.I was out of network and coventry authorized emergency,hospital stay,and tests. the total bill is about $21,000.
How is the process remediated by insurance?

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