Summary of Benefits and Coverages (SBC)

Insurance companies and group health plans are required to provide consumers with a concise document detailing, in plain language, simple and consistent information about health plan benefits and coverage. This summary of benefits and coverage document (SBC) will help consumers better understand the coverage they have and, allow them to easily compare different coverage options. It will summarize the key features of the plan or coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions.

Insurance Carrier

Summary of Benefits    (Qualified High Deductible)

Summary of Benefits (Benchmark)

Member Services

Find a Provider

Fallon Community Health Plan

SelectCare: 5550868

DirectCare: 5550865

SelectCare: 5550755

DirectCare: 5550751

1-800-868-5200

Plan: Select Care and Direct Care

Harvard Pilgrim Health Care

0189920008

0288480016

1-800-782-3675

Plan: HMO or PPO

Tufts Health Plan

57527-114

45843-114

1-800-462-0224

Plan: HMO

 Blue Cross/Blue Shield

00-4062726

00-4053585T

1-800-262-BLUE

Plan: HMO Blue New England

Delta Dental

High Plan: 010815-9902

Low Plan: 010815-9901

1-800-872-0500

Plan: Delta Dental PPO Plus Premier

EyeMed

1025891

1-888-4-EYEMED

Network: Insight


For more information on plan offerings please visit the West Suburban Health Group website.