Guide to your medical benefits

A Summary of Benefits and Coverage (SBC) is the document issued by your insurance carrier that describes what an insurance plan covers and the cost of various services. The first page of a medical SBC includes the name of the insurance carrier, the plan name, and the coverage period. The rest of the document lists categories of covered services and their associated costs. Toward the end of the document, your carrier also includes a few different medical scenarios and their potential costs—like a pregnancy, a simple fracture, and diabetes management. 

If you have questions about specific services or exclusions, call your insurance carrier at the phone number on the back of your member ID card. If you’re enrolled in benefits through Gusto, you can also find your carrier’s contact info in the Benefits section of your account. 

Find your Summary of Benefits in Gusto

If you're enrolled in Gusto-brokered health insurance (including the broker integration), follow these steps to find your SBC and other benefit details in Gusto:

  1. Sign in to your Gusto employee account.
  2. Go to the Benefits tab.
  3. Click the benefit you'd like to review.
  4. Click the link next to "Plan Name."

Understanding your Summary of Benefits

Here are the most important terms you'll find in a medical SBC and what they mean. 

Plan types  

Here's what each plan type and tier means. You can find your plan type at the top of your Summary of Benefits or in the plan name as listed in Gusto.  

Your provider network

Each plan has its own provider network, which is where you'll pay the least for covered services. 

Your costs for covered services

Once you determine your plan type and network, use your SBC to see what different healthcare services will cost you.

More insurance terms to know

Outside of your Summary of Benefits, here are some other terms you'll come across with your medical insurance. 

Note: This article is intended to be used as an example to help you understand your Summary of Benefits & Coverage and is not a description of your specific plan. To view your SBC, sign in to Gusto and click the Benefits tab where you will find your plan details.