News & Changes

Summary of Benefits and Coverage (SBC)

The federal government created the SBC to help people who are shopping for coverage when the health care exchanges opened in 2014. They let you see if different plans cover the same benefits (office visits, chiropractic care and prescription drugs, for example), and how much coverage they offer for those benefits—what the coinsurance and copayments are for different services. For that reason, we were not allowed to change much of the SBC to make it better fit with your benefits.

To best understand the benefits provided by this Fund, we recommend that you visit the Ironworkers Local 11 Benefit Funds and Training Facility website www.ironnj.com or the Horizon Blue Cross Blue Shield of New Jersey website www.horizonblue.com and read the materials that the Fund has created for you—your Summary Plan Description (SPD) and the other benefit materials that you are used to seeing from the Fund.

SBC Examples

  • The SBC includes two examples—one for having a baby and one for managing type 2 diabetes. The examples show the health care costs for you and the Fund that are involved with getting care for each of these two situations.

As you read these examples, it’s very important to keep in mind that the costs shown are national averages; they do not tell you what the actual services might cost where you live. Also, your doctor might choose a different course of treatment than what is used to create the example costs. Or your doctor could be an Out-of-Network Provider—the examples only show costs of In-Network Providers. There are lots of ways that your costs may be different than what is shown in the example even though you are dealing with the same thing—type 2 diabetes, for example.

These examples are included in the SBC to help you compare how different health plans might cover the same condition—not for predicting your own actual health care expenses.

SBC Terms

  • The SBC might use different terms than you are used to seeing when talking about your benefits. And there’s something called a “Glossary of Health Coverage and Medical Terms” mentioned in the SBC. The Glossary gives definitions of common health insurance terms. Unfortunately, it’s a national glossary and it may explain things differently than we usually do. But the government won’t let us change any of the definitions or even add some that might be helpful.
  • If you read the SBC or the Glossary and anything seems confusing or doesn’t quite line up with the way our Fund works, we suggest that you go to the Ironworkers Local 11 Benefit Funds and Training Facility website, the Horizon Blue Cross Blue Shield of New Jersey website, your SPD and the other benefit materials that you get from our Fund.

For More Information
If you have any questions about Fund-provided coverage, please call the Fund Office at (973) 376-7230 or Horizon at (800) 355-BLUE (2583).

If you have general questions about the SBC itself, you may want to contact the Employee Benefits Security Administration of the U.S. Department of Labor at (866) 444-3272 or www.dol.gov/ebsa, or the U.S. Department of Health and Human Services at (877) 267-2323 Ext. 61565 or http://www.cciio.cms.gov.

Please keep the SBC with your SPD for easy reference. Receipt of this document does not constitute a determination of your eligibility.

Please click this link to view the letter

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