SBC - Medical Equipment, Pediatric Dental and Vision, Excluded Services and Other Covered Services

The Summary of Benefits Coverage (SBC) explains the coverage for durable medical equipment, whether or not the plan covers dental and vision services for children, and goes over services that are explicitly excluded or provide coverage not detailed on this document.

This is the standard format for all SBCs up until April 1, 2017. Please refer to the SBC in question for details specific to that plan. The layout may differ but the same information will exist.

On this page, we can:

  • Continue learning about the coverage for additional Special Needs services.
  • View the benefit for durable medical equipment, like CPAP machines and other equipment.
  • Find out if pediatric dental and vision services are covered for dependents under 19, depending on the company's plan choice.
  • Learn more about excluded services and other covered services, like acupuncture, infertility treatments, and weight-loss programs.
  • Be aware of important Limitations and Exceptions, like visit limits or preauthorization/precertification requirements.

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