The Summary of Benefits and Coverage (SBC) is a snapshot of a health plan’s costs, benefits, covered healthcare services, and other features that are important to consumers. An SBC document also explains the unique features of health plans such as cost-sharing rules and includes significant limits and exceptions to coverage in easy-to-understand terms. This document helps users to compare health plans. The SBC is mandated by the Affordable Care Act (ACA) as a requirement for healthcare plans.

With Pega Product Composer for Healthcare, you can create templates that can be reused within your products or plans to create SBC documents for multiple products or plans. The template lets you merge specific fields, for example, benefit coverage with the corresponding copayment from a product or plan so that you create a Summary of Benefits and Coverage document that is specific to the product or plan.

You can also mass generate SBCs. This allows you to reflect changes in multiple products and plans in the SBC documents at one time. For example, if you needed to change the verbiage in a sentence in the SBC document, you can use SBC mass generation to update the SBC documents for your products and plans at once. You do not have to update each SBC document individually.

For more information, see the Pega Product Composer for Healthcare Implementation Guide on the Pega Product Composer for Healthcare product page.