Summary of Benefits and Coverage

Summary of Benefits and Coverage and Uniform Glossary Required Under the Affordable Care Act

SBC-Coverage-Examples-Calculator-Excel-11-2019.xlsm

Summary of Benefits and Coverage

OMB: 1210-0147

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(DT - OMB control number: 1545-0047/Expiration Date: 12/31/2019)(DOL - OMB control number: 1210-0147/
Expiration date: 5/31/2022)(HHS - OMB control number: 0938-1146/Expiration date: 10/31/2022)






Welcome to the Coverage Examples Cost Sharing Calculator






All insurer data entry fields are highlighted in orange.








The Cost Sharing Calculator operates in two modes.



Click the button that corresponds to the mode you want to use.









The user enters data for an individual plan and views the results.





The user loads data for multiple plans and runs the calculator.

The user can then browse the results for the individual plans, save



the results to an external file, or copy and paste the results for



the individual plans to a separate worksheet.






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