My benefits and coverage

A summary of benefits and coverage (SBC) is a document that shows deductible and copay information for common covered services under the plan.

An EOB or Explanation of Benefits is a statement that describes the costs of medical care received. It explains what portion of a claim was paid to the healthcare provider and what you will owe.  Download our Guide to Reading an EOB 

To request your EOB, please contact us at 833-600-1311.

If you sign-up during open enrollment and your first premium payment has been received, your coverage will begin January 1. If you enroll during a special enrollment period, your coverage start date is based on when you choose a plan. However, you cannot use your coverage until you make your first premium payment and your eligibility is confirmed.

 Key dates:

Special enrollment due to coverage loss:

Already lost coverage: Choose a plan within 60 days after coverage has ended. Submit documents within 30 days of choosing a plan. Coverage will begin the first day of the month after you choose your plan, if the premium is paid.

Will lose coverage in the future: Choose a plan 60 days before coverage will end. Submit documents within 30 days of choosing a plan. Coverage will begin the first day of the month after your coverage ends and you choose a plan, if your premium is paid.

Special enrollment due to move: Choose a plan within 60 days of moving. Submit documents within 30 days of choosing a plan. Coverage will begin the first day of the next month if the plan is chosen between the 1st and 15th and the premium is paid. Coverage will begin the first day of the second month if the plan is chosen between the 16th and the last day of the month and the premium is paid.

Special enrollment due to gaining a dependent: Choose a plan within 60 days after the event. Submit documents within 30 days of choosing a plan. Coverage will go back to the date of adoption, foster care placement or date the court order took effect if the premium is paid.

Special enrollment due to marriage: Choose a plan within 60 days after marriage. Submit documents within 30 days of choosing a plan. Coverage will begin the first day of the month after you choose a plan, if the premium is paid.

Yes, the Affordable Care Act requires that Marketplace plans cannot refuse coverage or charge you more just because you have a pre-existing condition. Pregnancy and childbirth are also covered.

If you move out of the area, you will need to update your address and reapply for coverage. This will be considered a special enrollment period.

The Advanced Premium Tax Credit is based on your family size and income. If you divorce your spouse, you will need to reapply for coverage under a special enrollment period. You will have 60 days from the date of the divorce to apply.